Three Cases of Colonic Pseudolipomatosis

Abstract

Colonic pseudolipomatosis is characterized by endoscopically, irregular-shaped and variable sized whitish plaques on colonic mucosa. Pathologic characteristics are aggregation of small-sized empty vacuoles in lamina propria which is similar to adipocytes. The mechanism is not clear, but mechanical trauma caused by endoscopic procedure or air inflation during procedure, endoscoic disinfectant such as paracetic or hydrogen peroxide is presumed to mechanism. Clinical features are benign condition with self-remission. We report three cases of multiple whitish plaques on colonic mucosa all of which were noted only during endoscopc withdrawal and miscoscopically demonstrated the finding similar to lipomatosis. Case 1 A 60-year-old male with no presenting symptom or underlying illness performed screening colonoscopy. On colonoscopic withdrawal, endoscopic finding was on the descending colon, several whitish plaques with variable sized and shape was noted. After salilne irrigation, foamy whitish surface became more demarcated. There was no definitive inflammatory sign including hyperemia, erosion or ulceration aound the plaques. Pathologic finding was in the lamina propria, empty vacuoles were noted. These clear empty spaces lack wall or endothelial lining. The clear empty spaces are located in upper portion of mucosal. After the procedure, he revealed no abdominal pain, fever or diarrhea Case 2 A 60-year-old female with lower abdominal discomfort performed colonoscopy. Colonoscopy revealed, at the ascending colon, two 5mm-szed polyps were removed by forcep procedures and at the hepatic flexure, multiple whitish plaques were noted. Histopathological examination showed empty vacuoles in the lamina propria were noted as well. No additional medication was needed after the procedure. Case 3 A 45-year-old male with familial history of colon cancer performed screening colonscopy. On the transverse colon, several whitish foamy plaques which was seen only withdrawal, were noted. Pathologically, empty vacuoles were noted in the lamina propria as well. No additional medication was needed after the procedure. Colonic psedolipomatosis is a kind of benign condition, which is supposed to be caused by endoscopic detergent or disinfectant. Although pseudolipomatosis is known to well-prognostic condition with no complication, special caution is still necessary using endoscopic disinfectant because of little experiences concerning its clinical course.