Gastrointestinal Lipomas Research Articles

Transoral Endoscopic Resection of Esophageal Liposarcoma

A 63-year-old man presented with a 1-month history of dysphagia. Endoscopy showed the patient had a mass in the cervical esophagus. Multiple biopsy specimens were taken, which were inconclusive for a diagnosis. A positron-emission tomography scan showed a hypermetabolic lesion. A transoral endoscopic approach was used to resect the tumor. Final histologic examination revealed a completely resected low-grade liposarcoma.

A Rare Case of Esophageal Submucosal Angiofibroma Resected Completely by Endoscopic Submucosal Dissection

a t a t l p A healthy man experienced the sensation of a lump in his throat, chest tightness, foreign body sensaion, and dysphagia for a half year before presentation. He was reated with antacids without any improvement initially. On xamination, the patient had mild tenderness over the epigasric region. Laboratory studies revealed a normal blood count, ormal biochemistry test results, carcinoembryonic antigen evel, and squamous cell carcinoma level. An esophagogasroduodenoscopy revealed a small bulging mass with intact ucosa (Figure A), estimated to be 5 mm in diameter, in the ower esophagus. A homogenous hypoechoic nodule, measurng 3.2 mm (Figure B), was discovered at the submucosal layer ia endoscopic ultrasound scanning. The overlying muscular ropria and mucosal layer were intact. Endoscopic submucosal issection (ESD) was performed under the impression of esophgeal submucosal tumor. A whitish tumor could be visualized n the deep submucosal layer after circumferential mucosal ncision by using a dual knife. The tumor then was removed ompletely by ESD (Figure C). The specimen was a whiteellowish elastic tumor measuring 5 mm. The pathologic findngs showed the tumor was an angiofibroma of the esophagus. he mitotic count of the tumor was low. The immunostains howed a positive reaction of cytokeratin, vimentin, actin, D34, and Ki67, and the proliferative index was 10% of angiobroma (Figure D). The patient had a good recovery without omplications after ESD. Submucosal tumors of the esophagus are not uncommon nd usually are detected incidentally by routine esophagogasroduodenoscopy examination. To our knowledge, leiomyomas re the most common neoplasm of an esophageal submucosal umor; gastrointestinal stromal tumor, lipoma, hamartoma, ymphangioma, squamous papilloma, and giant fibrovascular olyps are far less common.1 Patients usually are asymptomatic

Endoscopic submucosal dissection in the treatment of giant gastrointestinal lipomas

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of giant gastrointestinal lipomas.Methods From August 2007 to August 2010,the clinical data of 32 patients with giant gastrointestinal lipomas treated by ESD at Endoscopy Center,Zhongshan Hospital Fudan University were retrospectively analyzed.Among 32 cases of giant gastrointestinal lipomas,one case was in esophagus,six cases in stomach,two cases in duodenum,seven cases in ileocecal valve,15 cases in colon and one case in rectum. Preoperative diagnostic accuracy of endoscopic uhrasonography (EUS) was 93.8％ (30/32).The maximum diameter of tumor ranged from 3.0 cm to 8.0 cm (average 4.2 cm).Results All tumors were successfully dissected under endoscopy.The success rate was 100％ (32/32).The operation time was between 25 minutes and 110 minutes (average 37 minutes).The average intraoperative blood loss was 40 ml,and no perforation and delayed bleeding was found after ESD. All were proved to be lipomas by histopaphology after operation.The rate of follow-up was 90.6％ (29/32).The follow-up time was from six to 36 months.Conclusion ESD is a safe and effective method for the treatment of giant gastrointestinal lipomas,which can be applied extensively in clinical. Key words: Endoscopy, digestive system; Gastric mucosa; Intestinal mucosa; Gastrointestinal neoplasms ; Lipoma

Genotype-phenotype associations in neurofibromatosis type 1 (NF1): an increased risk of tumor complications in patients with NF1splice-site mutations?

Neurofibromatosis type 1 (NF1) is a complex neurocutaneous disorder with an increased susceptibility to develop both benign and malignant tumors but with a wide spectrum of inter and intrafamilial clinical variability. The establishment of genotype-phenotype associations in NF1 is potentially useful for targeted therapeutic intervention but has generally been unsuccessful, apart from small subsets of molecularly defined patients. The objective of this study was to evaluate the clinical phenotype associated with the specific types of NF1 mutation in a retrospectively recorded clinical dataset comprising 149 NF1 mutation-known individuals from unrelated families. Each patient was assessed for ten NF1-related clinical features, including the number of café-au-lait spots, cutaneous and subcutaneous neurofibromas and the presence/absence of intertriginous skin freckling, Lisch nodules, plexiform and spinal neurofibromas, optic gliomas, other neoplasms (in particular CNS gliomas, malignant peripheral nerve sheath tumors (MPNSTs), juvenile myelomonocytic leukemia, rhabdomyosarcoma, phaechromocytoma, gastrointestinal stromal tumors, juvenile xanthogranuloma, and lipoma) and evidence of learning difficulties. Gender and age at examination were also recorded. Patients were subcategorized according to their associated NF1 germ line mutations: frame shift deletions (52), splice-site mutations (23), nonsense mutations (36), missense mutations (32) and other types of mutation (6). A significant association was apparent between possession of a splice-site mutation and the presence of brain gliomas and MPNSTs (p = 0.006). If confirmed, these findings are likely to be clinically important since up to a third of NF1 patients harbor splice-site mutations. A significant influence of gender was also observed on the number of subcutaneous neurofibromas (females, p = 0.009) and preschool learning difficulties (females, p = 0.022).

Laparoscopic and endoscopic cooperative partial gastrectomy in the treatment of submucosal gastric neoplasms

To evaluate the feasibility of laparoscopic and endoscopic cooperative partial gastrectomy,a minimally invasive surgery, in treating gastric submucosa lesion. We retrospectively analyzed 63 patients [34 women and 29 men, aged (52.8±18.1) years (range:14 to 78 years)] who had undergone laparoscopic and endoscopic cooperative partial gastrectomy with preserving cardia and pylorus for gastric submucosal tumor in the past 6 years. All of the patients were followed up for 2-69 months (average 35 months). The clinicopathological data, surgical approaches, and follow-up results were analyzed. The surgery was successfully performed in all these 63 patients, among whom 61 were assisted by endoscopy. The most common symptom was dyspepsia. The mean distance from the lesions locating at fundus or antrum to cardia or pylorus was(2.9±1.1)cm. The minimum distance from tumor edge to cardia was 1cm. The diseases included gastrointestinal stromal tumor (n=54), carcinoid tumors (n=3), ectopic pancreas (n=2), lipoma (n=2), and leiomyoma (n=2). The tumor size ranged from 0.8 to 8.2cm, with 44 lesions (69.8%) less than 2cm. Forty-five lesions(71.4%) were located at fundus, 12 (19.0%) at body, and 6 (9.6%) at antrum. No recurrence or death was noted during follow-up. Laparoscopic and endoscopic cooperative partial gastrectomy is feasible for treating gastric submucosal tumor. Endoscopy is useful for intraoperative localization and supporting, and therefore is especially helpful for preserving cardia and pylorus.

Adult intussusceptions caused by a lipoma in the jejunum: report of a case and review of the literature

Intussusceptions in adults is rare. Gastrointestinal lipomas are rare benign tumors and intussusceptions due to a gastrointestinal lipoma constitutes an infrequent clinical entity. Lipoma may develop as a benign tumor in all organs and rarely in large or small intestine. The present report describes a case of jejunojejunal intussusceptions in an adult with a history of colicky upper abdominal pain. Ileo-ileal invagination was diagnosed by computed tomography scan. Exploratory laparotomy revealed jejunojejunal intussusceptions secondary to a lipoma which was successfully treated with segmental intestinal resection. A review of the literature is also performed regarding this rare association revealing the diagnostic and therapeutic debates that exist. (french)L’invagination chez les adultes est rare. Les lipomes gastro-intestinaux sont de rares tumeurs bénignes et l’invagination intestinale due à un lipome gastro-intestinal constitue une entité clinique trés rare. Le lipome peut se développer comme une tumeur bénigne dans tous les organes et rarement dans l’intestin grêle ou le colon. Le présent rapport décrit un cas d’invagination jéjunojéjunale chez un adulte avec une histoire de douleurs abdominales. Iléo-iléale invagination a été diagnostiquée par tomodensitométrie. Une laparotomie exploratrice a révélé l’existence d’une invagination jéjunojéjunale secondaire à un lipome qui a été traitée avec succès par une résection intestinale segmentaire. Une revue de la littérature est également effectuée au sujet de cette association rare révélant les débats diagnostiques et thérapeutiques qui existent.

Lipomas of the gastrointestinal system

Lipomas are rare benign tumors in the gastrointestinal system. Within the gastrointestinal system, 65% of the lipomas are located in the colon (sigmoid part of the colon or rectum) and rarely in the stomach and esophagus. The paper presents two gastrointestinal lipomas. First is the case of lipoma of the sigmoid colon and the other one is gastric lipoma. In both cases the material was sent for histopathological analysis due to suspicion of malignancy of the lesions. In both cases, the histopathologic analysis showed tumor made of mature adipocytes, localized in the submucosa both of the stomach and intestine. Hypercellularity and/or atypia of the cell was found in neither case. Lipomas are shown because of its atypical localization and clinically suspicious malignancy in the stomach and sigmoid colon. These cases show that the applied methods of preoperative diagnosis of tumors in the gastrointestinal system are not sufficient to determine the origin and biological behavior of tumors. Histopathological diagnosis provides a correct insight into the nature of tumors and determine the course of treatment. This paper presents a rare localization of lipomas in the gastrointestinal system. The preoperative diagnosis of lesions in the gastrointestinal system may not be sufficient to determine the origin and biological behavior of the lesions, hence the histopathological diagnosis gives an accurate insight into the nature of the change, preventing the possibility of further aggressive therapy.

Case of a Giant Colonic Lipoma That Was Endoscopically Removed by Strangulation with Repetitive Endoloop Ligation

Colonic lipomas are the most common tumors of mesenchymal origin in the large intestine. These tumors are typically found in the colon, but are also discovered in the small bowel, stomach, and esophagus. Most gastrointestinal lipomas are asymptomatic and are discovered incidentally during endoscopy or surgery. Large lipomas can cause abdominal pain, gastrointestinal bleeding, obstruction, and intussusceptions and therefore require resection. Surgical resection is typically only considered for the removal of giant lipomas > 2 cm because of concerns regarding the high complication risk of endoscopic resection. New techniques that use endoscopic snare polypectomy with endoloops or endoscopic resection with an endoloop after an unroofing technique have recently been reported. We herein report a case of a 7-cm giant colonic lipoma that was removed by an endoscopic unroofing technique and repetitive endoloop ligation and strangulation. (Korean J Med 2012;83:221-225)

Gastric lipoma presenting as obstruction: Role of intraoperative frozen section in diagnosis

Lipomas are benign tumors of adipose tissue. Lipomas are rare in the gastrointestinal tract, located mostly in the colon. Gastric lipomas are very rare constituting 5% of all gastrointestinal lipomas. We report a case of a large submucosal gastric lipoma presenting with features of gastric obstruction. The frequency of gastric lipoma, its differential diagnosis, means of diagnosis, and treatment are discussed.

Safe Techniques for Endoscopic Resection of Gastrointestinal Lipomas

Gastrointestinal (GI) lipomas are rare, benign, slowly growing, submucosal tumors, which can either be incidentally found as silent tumors of the GI tract or be the cause for GI bleeding, anemia, intussusception, and bowel obstruction. Endoscopic removal is a valid alternative to surgical resection of these tumors. In the recent past, many submucosal lipomas were for the most part resected surgically due to the risk of perforation using endoscopy. There are newer techniques available to allow safe endoscopic removal of these lesions. We present 3 successful techniques tailored to the location of the lipoma and size. In our unit, 3 symptomatic GI lipomas were referred to us for surgical resection, 2 originating from the duodenum and 1 from the cecum were diagnosed and resected under endoscopic ultrasound and endoscopy. We performed 3 different techniques to remove these lipomas. One of the lipomas in the duodenum was in the duodenal bulb. It was mobile and 3 cm in size. We attempted to remove this broad-based lipoma by snare and cut technique after its borders were elevated with injection of saline and epinephrine. The second duodenal lipoma was 1.5 cm. This pedunculated lipoma was located in the second portion, on the pancreatic side of the duodenum proximal to ampulla. This lipoma was lifted up with a snare and its base was cauterized resulting in successful removal. The third GI lipoma was 3.5 cm in size pedunculated and located in the cecum. The base of this pedunculated lipoma was ligated with poly loop device and endoclip resulting in ischemia and spontaneous separation of the lipoma from the colonic wall. All cases were revisited with follow-up endoscopy. All 3 methods, when used selectively, were found to be very safe and effective. All 3 lesions were successfully removed and histopathologically confirmed to be lipomas. After endoscopic removal, no complications were observed. Carefully selected GI lipomas, which in the past have required surgical resection due to high risk for perforation can be endoscopically removed with great success.

A Case of Gastric Lipoma Removed Using a Detachable Snare

Gastrointestinal lipoma is a benign tumor of mature adipose tissue, surrounded by fibrous capsule. They can be located anywhere in the gastrointestinal tract, but rarely in the stomach, especially at the cardia. Gastric lipoma accounts for approximately 2∼3% of all benign gastric tumors, and 5% of all gastrointestinal lipomas. Lipoma tends to have very low malignant potential, but if it induces symptoms like abdominal pain or hemorrhage, it needs to be removed. We report a case of gastric lipoma which was successfully removed by only using a detachable snare. A 72-years-old woman who had no specific symptom was found to have a submucosal tumor at cardia. During endoscopy, the fatty internal material accidently came out after tearing the mucosa with biopsy, and it was successfully removed using a detachable snare. (Korean J Helicobacter Up Gastrointest Res 2011;11:198200)

Dose Endoscopic Ultrasonography Impact Diagnosis of Intestinal Diseases?

Substantial development in equipment such as miniprobe endosonography and enteroscopy has made it possible to use endoscopic ultrasonography (EUS) to detect any part of the digestive tract. EUS plays a vital role in evaluating a lower intestinal malignancy, particularly rectal cancer, to determine whether the disease is localized (T1-2, N0) and appropriate for surgery or locally advanced (T any, N1-2) and would benefit from preoperative neoadjuvant chemoradiation. Moreover, follow-up by EUS may contribute to early recognition of focal tumor recurrence, particularly for lesions that cannot be detected by other imaging modalities. EUS is also an invaluable modality for diagnosing intestinal submucosal tumors, such as gastrointestinal stromal tumors, lipomas, lymphangiomas, leiomyomas, carcinoids, and others such as intestinal endometriosis. Although a definite diagnosis of a submucosal tumor is generally confirmed by cytology or histology results, EUS-guided fine needle aspiration or core biopsy is a fairly helpful practice. EUS is also useful for discriminating between Crohn`s disease and ulcerative colitis as well as assessing disease severity. Moreover, it has emerged as a powerful imaging tool to manage perianorectal diseases. EUS also has the potential to be useful for intra-small intestinal ultrasonography for the diagnosis of small bowel diseases in the future. (Intest Res 2011;9:179-188)

Digital Image Analysis Is a Useful Adjunct to Endoscopic Ultrasonographic Diagnosis of Subepithelial Lesions of the Gastrointestinal Tract

The purpose of this study was to explore the role of digital image analysis in differentiating endoscopic ultrasonographic (EUS) features of potentially malignant gastrointestinal subepithelial lesions (SELs) from those of benign lesions. Forty-six patients with histopathologically confirmed gastrointestinal stromal tumors (GISTs), carcinoids, and lipomas who had undergone EUS evaluation were identified from our database. Representative regions of interest (ROIs) were selected from the EUS images, and features were extracted by texture analysis. On the basis of these features, an artificial neural network (ANN) was built, trained, and internally validated by unsupervised learning followed by supervised learning. Outcomes were the performance characteristics of the ANN. A total of 106, 111, and 124 ROIs were selected from EUS images of 8, 10, and 28 patients with lipomas, carcinoids, and GISTs, respectively. For each ROI, 228 statistical parameters were extracted and later reduced to the 11 most informative features by principal component analysis. After training with 50% of the data, the remainder of the data were used to validate the ANN. The model was "good" in differentiating carcinoids and GISTs, with area under the receiver operating characteristic curve (AUC) values of 0.86 and 0.89, respectively. The model was "excellent" in identifying lipomas correctly, with an AUC of 0.92. Digital image analysis of EUS images is a useful noninvasive adjunct to EUS evaluation of SELs.

Small Bowel Intussusception in an Adult due to Lipoma: a Rare Cause of Obstruction. Case report and Literature Review

Intussusception in adults is rare. The clinical picture of intussusception in adults is subtle and the diagnosis is, therefore, elusive. The presence of a structural abnormality in the great majority of the adult cases mandates high clinical suspicion. Gastrointestinal lipomas are rare benign tumors and intussusception due to a gastrointestinal lipoma constitutes an infrequent clinical entity. The present report describes an unusual case of adult intussusception caused by a lipomatous polyp of terminal ileum with nonspecific abdominal symptoms. The diagnosis of intussusception was finally raised by a computed tomography (CT) scan of the abdomen.

Spindle cell lipoma of the esophagus

Esophageal lipomas are benign tumors representing less than 0.5% of all gastrointestinal lipomas. They are typically detected incidentally but occasionally present with local symptoms and rarely with life-threatening complications. We describe a case of a 60-year-old man with progressive dysphagia and weight loss, who presented with several episodes of near asphyxiation secondary to regurgitation and aspiration of the pedunculated mass. Preoperative investigations included a barium meal, esophagoscopy and computerized tomography. The pedunculated lipoma was excised via a cervical approach and found, at final pathology, to be a spindle cell lipoma, a rare variant not previously described in relation to the esophagus.

A Rare Ileal Intussusception Caused by a Lipoma of the Ileum

Adult intussusception is a rare disease and it differs from childhood intussusception in its presentation, cause and treatment. Most of the cases have an underlying lesion within the intussusception that requires surgical resection. Making the diagnosis can be delayed because of the nonspecific and chronic symptoms, and many cases are diagnosed during performance of emergency laparotomy for treating the obstructive symptoms. A computed tomography (CT) scan is most useful for making the diagnosis of adult intussusception and is helpful in revealing the underlying lesion, although a barium enema can help to diagnose colonic intussusceptions. Surgical resection remains the recommended treatment for nearly all cases, but there is controversy about whether or not the intussusception should be initially reduced before resection. Gastrointestinal lipomas are rare benign tumors that can occur anywhere along the gut, and the small bowel is the second most common site for gastrointestinal lipomas after the colon. Intussusception of the ileum by a lipoma is very rare. We report here on a case of ileo-ileal intussusception that was caused by a lipoma of the ileum in a 35-year-old man who complained of abdominal pain of one week duration. The diagnosis of an ileo-ileal intussusception caused by a lipoma of the ileum was suspected preoperatively according to the typical CT findings, so we tried to initially reduce the intussusception during laparotomy. But manual reduction was impossible due to the edema of the lesion, and an ileum of some length had to be resected.

Computed Tomographic and Magnetic Resonance Imaging Findings of Asymptomatic Intra-Abdominal Gastrointestinal System Lipomas

Lipomas are common benign mesenchymal neoplasms documented in literature. This study aimed to describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings of gastrointestinal system lipomas, all of which are incidentally found in routine abdominal imaging studies. Lipomas were depicted as homogeneous, nonenhancing, well-marginated lesions consistent with adipose tissue on CT and MRI. The density measurements on CT images consistent with fat are virtually diagnostic. Lipomas can incidentally be found and should be considered in the differential diagnosis of soft tissue gastrointestinal system-related masses. Computed tomographic or MRI examinations can correctly diagnose a lipoma nonoperatively, thereby allowing better treatment planning.

NFIB rearrangement in superficial, retroperitoneal, and colonic lipomas with aberrations involving chromosome band 9p22

Lipomas are frequently characterized by rearrangements resulting in the fusion of the HMGA2 gene (12q14.3) with a variety of partners. Chromosome band 9p22 rearrangements occur in about 1% of lipomas. We report here the molecular cytogenetic analysis of five cases of lipoma with a 9p22 aberration, including the first cytogenetic analysis of a colonic lipoma. Three out of the five cases showed a rearrangement of NFIB at 9p22.3. The NFIB rearrangement involved a fusion with HMGA2 in two cases. We have identified an in-frame fusion of the first three exons of HMGA2 with exon 6 of MSRB3 (12q14.3) and exons 8 and 9 of NFIB by using 3'RACE-PCR in a case of superficial lipoma. In a case of retroperitoneal lipoma we found a fusion of HMGA2 with NFIB by fluorescence in situ hybridization analysis. The colonic lipoma was characterized by a t(9;16;19)(p22;q21;q13) with a rearrangement of NFIB and no rearrangement of HMGA2. NFIB belongs to the nuclear factor I transcription family. It has been previously shown to be fused with HMGA2 in one case of lipoma and to be a recurrent partner of HMGA2 in pleormorphic adenoma of salivary glands. We here demonstrate that NFIB can also be rearranged independently from HMGA2, indicating a potentially important role in lipoma pathobiology. Our findings suggest that the rearrangement of NFIB might be associated with deep-seated lipomas, such as retroperitoneal or gastro-intestinal lipomas.

Values of endoscopic ultrasonography for diagnosis and treatment of duodenal protruding lesions

The diagnoses of patients with duodenal protruding lesions are difficult when using conventional examinations such as computed tomography (CT) and conventional endoscope etc. Thus, we investigated the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes on the diagnosis and treatment of duodenal protruding lesions. Patients with duodenal protruding lesions who were indicated for EUS were examined by EUS with 12 approximately 15 MHz miniature ultrasonic probes and double-cavity electronic endoscope. According to diagnosis of EUS, those patients were indicated for biopsy and treatment received biopsy, endoscopic resection or surgical excision. The postoperative histological results were compared with the preoperative diagnosis of EUS. Those patients without endoscopic resection or surgical excision were periodically followed up with EUS. A total of 169 patients with duodenal protruding lesions were examined by EUS, of which 40 were diagnosed with cysts, 36 with inflammatory protruding or polyp, 25 with Brunner's gland adenoma, 19 with ectopic pancreas, 17 with gastrointestinal stromal tumor, 12 with extrinsic compression, 12 with minor papilla, 6 with lipoma, 1 with adenocarcinoma and 1 with lymphoma. After EUS examinations, 75 patients received biopsy, endoscopic resection or surgical excision respectively. The postoperative histological results of 70 patients were completely consistent with the preoperative diagnosis of EUS, with 93.33% diagnostic accuracy. The results of follow-up with EUS indicated that duodenal cyst, Brunner's gland adenoma, ectopic pancreas, gastrointestinal stromal tumor and lipoma remained unchanged within 1 approximately 3 years. No related complications occurred among all patients that received EUS examinations. EUS is an effective and reliable diagnostic method for duodenal protruding lesions.

Hepatobiliary and pancreatic: Pancreatic lipoma

What are the common sites for gastrointestinal lipomas? The most common is the large bowel (70%) but other sites include the small bowel (25%) and stomach (5%). Lipomas can also occur in the pelvis and in the mesentery and, rarely, in organs such as the pancreas. In relation to pancreatic lipomas, the most helpful investigations are computed tomography (CT) and magnetic resonance (MR) scans. Typical findings on CT include a hypodense lesion with attenuation values consistent with fat. With MR imaging, the boundaries of the fat are often more clearly seen and the lesion is isointense with surrounding adipose tissue on T1 and T2-weighted images. Neither CT nor MR show contrast enhancement in lipomas. The differential diagnosis of a pancreatic lipoma includes focal fatty infiltration, teratoma and liposarcoma. In contrast to a lipoma, focal fatty infiltration does not have a distinct collagen capsule and often blends with peripancreatic adipose tissue. Teratomas usually have other diagnostic characteristics but it may be more difficult to differentiate lipomas from liposarcomas. With the latter disorder, the margin of the lesion can be more irregular and there may be greater variation in fat attenuation. The patient illustrated below was a 47-year-old woman who was referred for a CT scan because of hepatic hemangiomas. The scan also demonstrated a hypodense lesion, 22 × 17 mm in size, in the head of the pancreas. The lesion had an attenuation coefficient of −57 HU on axial images consistent with fat. There was no contrast enhancement during the arterial or venous phases. The appearance of the lesion (arrow) on the arterial phase is shown in Figure 1. A T1- weighted MR image revealed a hyperintense lesion in the head of the pancreas that was isointense with peripancreatic adipose tissue and subcutaneous fatty tissue. In a fat- suppressed T1-weighted image (Fig. 2), the lesion was suppressed and there was no evidence of enhancement by radiologic contrast. On a T2-weighted image, the lesion was isointense with peripancreatic adipose tissue. These features are typical of a pancreatic lipoma. Contributed by