Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2019; 7(2): 209-214
Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.209
Cecal lipoma with subclinical appendicitis: A case report
Kuen-Jang Tsai, Yun-Sheng Tai, Chao-Ming Hung, Yue-Chiu Su
Kuen-Jang Tsai, Chao-Ming Hung, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
Yun-Sheng Tai, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
Yue-Chiu Su, Department of Pathology, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 82445, Taiwan
Author contributions: Tsai KJ drafted the manuscript; Tai YS reviewed the literature; Hung CM revised the article critically; Su YC analyzed and interpreted the histopathological samples; all authors read and approved the final manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yun-Sheng Tai, MD, Chief Doctor, Department of Surgery, E-Da Hospital, I-Shou University, No. 1 Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan. ed109633@edah.org.tw
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Received: August 31, 2018
Peer-review started: September 2, 2018
First decision: October 4, 2018
Revised: December 23, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 26, 2019
Processing time: 148 Days and 6.1 Hours
Abstract
BACKGROUND

Colonic lipomas are rare, slow-growing benign tumors. Colonic lipomas are generally asymptomatic and are found incidentally. Although cases of cecal lipoma have been sporadically reported in the literature, the disease has not been systematically reviewed.

CASE SUMMARY

We present a 44-year-old man who underwent a routine physical check-up during which colonoscopic examination revealed an asymptomatic 1.5-cm cecal mass at the appendiceal orifice. Laparoscopic exploration was performed that also demonstrated a congested and erythematous appendix. En bloc resection of both the cecum and vermiform appendix was performed because of the suspicion of malignancy. Histopathological examination revealed a cecal lipoma composed of mature adipose tissue, and the appendix showed subclinical inflammation. Our procedures and findings were discussed, along with relevant English literature that was retrieved from the PubMed database from 2000 to 2017. Twenty-six cases, including ours, were reported. Consistent with the findings of the literature, it is difficult to obtain a definitive diagnosis by colonoscopic biopsy.

CONCLUSION

Surgery remains the treatment of choice for this condition. Intraoperative frozen pathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis. The prognosis is generally good, with only one of the 26 reported patients complicated with acute appendicitis, who subsequently succumbed due to severe comorbidities and sepsis.

Keywords: Cecal lipoma; Appendicitis; Intussusception; Case report

Core tip: All patients with cecal lipoma reported in the literature were treated with radical right hemicolectomy because malignancy could not be completely ruled out before surgery. However, in our presented case, intraoperative frozen histopathological sectioning helped the surgeon decide the extent of surgery, and radical surgery was avoided. Furthermore, excision of benign lesions occupying the appendiceal orifice may be indicated for the prevention of later development of acute appendicitis.