Mesenteric Lipoma in a Child

Abstract

IT IS GENERALLY known among radiologists that fat is translucent to roentgen rays, casting a shadow intermediate in density between that of air and water. According to Laurell (18), this observation was first recorded by A. Köhler, in 1915, and subsequently by Grashey, in 1924. The first lipomas to be observed roentgenographically were situated mainly in the extremities. Thus, Bufalini (7) in 1925 reported an intramuscular lipoma of the arm, revealed on roentgen examination by its relatively radiolucent shadow. The first instances of intra-abdominal fatty tumors actually visualized preoperatively were three cases published by Odqvist (21) in 1926. All three had been diagnosed roentgenologically as dermoids, and in two this diagnosis was confirmed at operation. The third proved to be a retroperitoneal lipoma, and it will be shown later that this error in differential diagnosis is frequently unavoidable. It should be emphasized that previous publications had dealt exclusively with fatty tumors in more superficial locations. More recently Windholz (33) has reported the preoperative diagnosis of three fatty retroperitoneal tumors, of which two were lipomas and one a fibromyxoliposarcoma. In Table I are presented the publications dealing with the roentgen diagnosis of radiolucent fatty tumors. The great majority of the 33 reported visualized tumors have been lipomas of the extremities. Only 7 have been demonstrable in deep sites (Table II). There have also been a number of reports of fatty tumors which either were not visualized or appeared only as a dense mass. In every instance, the tumor was deeply situated within the abdominal cavity. Some of these reports are listed in Table III. It is evident from the foregoing review that fat-containing tumors have heretofore been reported as casting a shadow of diminished density in the following sites, in decreasing order of frequency: (a) intramuscular (lipomas); (b) retroperitoneal (lipomas, liposarcoma); (c) intraperitoneal (dermoids); (d) intracranial (lipoma). Lipomas occurring within the mesentery are exceedingly rare, particularly in children. Summers (29) reviewed 128 solid mesenteric tumors and could find only one example of mesenteric lipoma in a child, as compared with 16 other types of solid tumor in this location in children. In 1941, Bass (3) reviewed the literature, finding two previously reported mesenteric lipomas in children. He added a third, occurring in a two-year-old boy. Although roentgen examination showed displacement of the intestines by the mass, no mention was made of the relative density of its roentgen image., Ladd and Gross (16) do not mention the occurrence of mesenteric lipomas in children. In view of the fact that no previous publication has been found in which a mesenteric lipoma was revealed roentgenographically as a radiolucent mass,