Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

ABDOMINAL IMAGING
Year
: 2003  |  Volume : 13  |  Issue : 1  |  Page : 41--42

Mesenteric lipoma : A rare benign tumor in the pediatric abdomen


RD Dani, V Gandhi, GN Thakkar, KI Parmar, K Nanavati 
 Smt. S.C.L. Municipal General Hospital, Saraspur, Ahmedabad, India

Correspondence Address:
R D Dani
Smt. S.C.L. Municipal General Hospital, Saraspur, Ahmedabad
India




How to cite this article:
Dani R D, Gandhi V, Thakkar G N, Parmar K I, Nanavati K. Mesenteric lipoma : A rare benign tumor in the pediatric abdomen.Indian J Radiol Imaging 2003;13:41-42


How to cite this URL:
Dani R D, Gandhi V, Thakkar G N, Parmar K I, Nanavati K. Mesenteric lipoma : A rare benign tumor in the pediatric abdomen. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Jul 2 ];13:41-42
Available from: http://www.ijri.org/text.asp?2003/13/1/41/28625


Full Text

 Introduction



Primary solid tumors of the mesentery are rare. Fatty masses, especially solid lipomas, in the pediatric abdomen are very rare. We would like to report such a case diagnosed by US and CT.

 Case report



A five years old girl was admitted with progressive distension of the abdomen. On clinical examination, a mobile lump soft in consistency was palpated in abdomen. Plain radiograph of the abdomen [Figure 1] demonstrated a large soft tissue opacity displacing bowel loops to the left side and superiorly. On the US examination a [Figure 2] well defined, echogenic mass measuring 96mm x 55mm was seen in the abdomen with few hypoechoic liner septations. No calcification was noted within the mass lesion. Bowel loops were displaced to left side. The mass also changed location under transducer compression and change in position of the patient. No evidence of bowel obstruction or hydronephrosis was noted on either side. Colour Doppler US did not reveal any vascularity within the mass lesion. On the basis of the above findings the possibility of a mesenteric lipoma was considered.

On CT, a well encapsulated, nonenhancing mass of fat density (negative attenuation value -90 HU) with isodense internal septations was seen. No calcification or significant non-fatty solid component was noted within the mass lesion. CT confirmed the US findings.

The tumor was enucleated from the mesentery leaving the Intestine intact. The diagnosis of a simple lipoma arising in the leaves of the small bowel mesentery, without immature cells, was verified microscopically.

 Discussion



Mesenteric lipoma is a localized, encapsulated collection

of fat. Macroscopically, it is a well circumscribed fatty mass with a thin transparent fibrous capsule. Internal septations are unusual. Microscopically, it is composed of well differentiated mature adipocyte and is surrounded by a fibrous capsule [1].

Solid lipomas in the pediatric abdomen are very rare [1]. On US, lipoma has a well defined, homogenous, echogenic capsule [2]. It changes location under probe compression [3]. Color Doppler US reveals the avascular nature of the mass [3]. On CT, it is a sharply marginated, homogenous mass which shows negative attenuation ( equal to normal subcutaneous fat ) and no contrast enhancement [2]. The capsule may or may not be visible and internal septations are unusual [2]. The differential diagnosis includes a lipoblastoma and well differentiated liposarcoma which cannot be ruled out on the basis of imaging findings alone [2] [4]. Confirmation requires histopathological study.

For a liposarcoma, four distinct CT patterns have been described [2].

1. Poorly differentiated tumors with little fat, presenting as solid soft tissue masses,

2. Well-differentiated tumors presenting as heterogenous masses with discrete fatty and soft tissue masses.

3. Well-differentiated, homogenous, circumscribed, low density masses indistinguishable from normal fat or lipoma (as in this case ) .

4. Tumors with a pseudocystic appearance containing a mixture of fat and solid connective tissue.

US and CT findings suggest the fat containing mesenteric mass. It can be either a lipoma, lipoblastoma or a well differentiated liposarcoma.

Histopathological study is required to differentiate these tumors. Here, we underline the importance of US and CT as preoperative diagnostic tools.

References

1Kaniklides c; Frykberg R; Lundkvist K; Paediatric mesenteric lipoma, an unusual of repeated abdominal pain. A case report. Acta radiological Nov 1998; 39; (6); 695-697.
2R. G. Grainger, D.J.Allison (eds) Diagnostic Radiology : Imaging of mesentery and omentum, Churchill - Livingston, New York. 1060-1062.
3Sato M. et al, Mesenteric lipoma : report of a case with emphasis of US finding. European Radiology April 2002 12; (4); 793-795
4Ilhan et al, Giant mesenteric lipoma. Journal of pediatric surgery, Apr 1999; 34 (4) 639-640.