Colonic Pseudolipomatosis: A Rare but Characteristic Endoscopic Condition

Area of Science:

• Gastroenterology
• Pathology
• Endoscopy

Background:

• Colonic pseudolipomatosis (CP) is a rare condition with unclear etiology and pathogenesis.
• Potential causes include iatrogenic mucosal injury or chemical injury from endoscope disinfectants.
• Diagnostic imaging like CT/MRI is not contributory, and CP can be mistaken for pre-malignant lesions.

Observation:

• A case of a 65-year-old man with a family history of colorectal cancer is presented.
• Colonoscopy revealed confluent whitish, laterally-spreading lesions in the cecum and ascending colon with a round pit-pattern.
• Histopathology showed mucosal cysts filled with gas and a mild inflammatory infiltrate.

Findings:

• Histopathology confirmed colonic pseudolipomatosis with gas-filled cysts in the mucosal layer.
• A mild inflammatory process with mononuclear cells and eosinophils was noted.
• Preserved architectural organization and tissue maturation, with no nuclear atypia, supported the benign diagnosis.

Implications:

• Colonic pseudolipomatosis is a benign condition requiring no further investigation or treatment.
• Accurate differentiation from pre-malignant lesions like lateral-spreading tumors is essential.
• Proper diagnosis prevents unnecessary interventions such as endoscopic mucosal resection.