Omental lipoma is an extremely rare abdominal tumor that, despite its large size, often remains asymptomatic. A giant lipoma arising from the greater omentum in a  21-monthold girl is reported. The mass was excised completely and the patient is doing well at the 12-month follow-up, with no recurrence. Nontender lobulated mobile mass, location, and uniformly low attenuation on computed tomography were diagnostic.Keywords: abdominal tumor, giant lipoma, omentu

Garge, Saurabh

Menon, Prema

Rao, Katragadda Laxmi Narasimha

English

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Giant omental lipoma: report of a case with reviewof the literatureSaurabh Garge, Prema Menon and Katragadda Laxmi Narasimha RaoOmental lipoma is an extremely rare abdominal tumor that,despite its large size, often remains asymptomatic. A giantlipoma arising from the greater omentum in a 21-month-old girl is reported. The mass was excised completely andthe patient is doing well at the 12-month follow-up, with norecurrence. Nontender lobulated mobile mass, location,and uniformly low attenuation on computed tomographywere diagnostic. Ann Pediatr Surg 10:22–24 c 2014Annals of Pediatric Surgery.Annals of Pediatric Surgery 2014, 10:22–24Keywords: abdominal tumor, giant lipoma, omentumDepartment of Pediatric Surgery, PGIMER, Chandigarh, IndiaCorrespondence to Saurabh Garge, MS, MCh, Department of PediatricSurgery, APC-3A, PGIMER, 160012 Chandigarh, IndiaTel: + 91 987 869 1012; fax:+ 91 1722755642;e-mail: saurabhgarge8@gmail.comReceived 15 November 2012 accepted 26 October 2013IntroductionLipoma of the greater omentum is an extremely rarebenign abdominal childhood tumor, with only nineprevious reports in the literature [1–9]. We report a giantomental lipoma in a 21-month-old girl that was com-pletely excised. This also involved resection of a partof the spleen.Case reportA 21-month-old girl weighing 12 kg presented with ahistory of progressive, painless abdominal distension forthe past 2 months. A nontender, firm, lobulated massoccupying most of the left half of the abdomen and alsocrossing the midline was palpable. The fingers could notbe insinuated between the left costal margin and themass. The mass had side-to-side mobility and wasbimanually palpable. There was a 3 2 cm café au laitpatch over the swelling. A plain radiograph of theabdomen showed a homogenous ground-glass appearanceon the left side of the abdomen with no calcification.Ultrasonograph (USG) suggested a large retroperitonealnoncystic mass displacing the left kidney posteroinfe-riorly. Serum a fetoprotein level was 1.9 ng/ml (< 5 ng/mlnormal value). Contrast-enhanced computed tomography(CT) scan of the abdomen indicated a large well-definedintraperitoneal lesion with a predominant fat component(– 80 to 100 HU) with multiple septa within (Fig. 1).Laterally, it abutted the abdominal wall and poster-osuperiorly it was related to the pancreas. The splenicvein was compressed by the mass and it had displaced thesuperior mesenteric vessels to the right. There was noretroperitoneal lymphadenopathy or ascites. The absenceof calcification on CT, normal a fetoprotein, and presenceof a normal kidney and adrenals negated the diagnosis ofteratoma, hepatoblastoma, nephroblastoma, and a cysticneuroblastoma. Thus, other tumor markers were notmeasured. A provisional diagnosis of omental lipoma wasmade on the basis of the characteristic fat attenuation onCT. Biopsy was not performed because the mobile, well-defined nature of the mass indicated a benign resectablelesion. At laparotomy, a lobulated, yellowish tumormeasuring 20 14 9 cm arising from the greater omen-tum and occupying the intraperitoneal compartment aswell as the lesser sac was found (Fig. 2). It was alsoattached to the tip of the lower pole of the spleen, whichhad to be excised. The tumor weighing 2 kg was removedin toto. Histopathological examination showed a well-encapsulated tumor composed of mature adipocytes.There were no atypical lipoblasts, increased vascularity,or myxoid changes.The patient had an uneventful recovery and wasdischarged from the hospital on the fifth postoperativeday. She remains asymptomatic at the 12-month follow-up, with no evidence of recurrence on follow-up USG.DiscussionIntraperitoneal lipomas are rare in childhood. Only sevencases have been reported so far arising from the greateromentum [1–7]. When cases of lipoblastomas are added,the tally comes to about nine cases [7–9]. Thesepresented from the age of 9 months to 13 years [1–9](Table 1). No sex predilection has been noted so far.There is gradual abdominal distension or a palpablelump [1,4–9]. Early satiety, vomiting, and abdominal painowing to pressure effects on surrounding structures or anemergent presentation because of torsion or partialintestinal obstruction have been reported [2,3,9,12].The differential diagnosis includes teratoma, lymphan-gioma, lymphoma, alimentary tract duplications, andneuroblastoma. Lipomas are homogeneous, highly echo-genic, and encapsulated on USG. A lymphoma is usuallyhypoechoic and a neuroblastoma is often highly echo-genic. Another close differential is lipoblastoma, whichappears as a well-defined hypoechoic myxoid massembedded within highly echogenic fat [13]. Identifica-tion of fat with CT is on the basis of an attenuation ofless than B20 HU. Other lesions with predominantmacroscopic fat include teratoma, myelolipoma, angio-myolipoma, liposarcoma, lipoma, epiploic appendagitis,and omental infarction [11].The histology in lipoma will show lobules of matureadipocytes, whereas in lipoblastoma, the cells will rangefrom immature lipoblasts to mature adipocytes and thecells may be separated by fibrous septa [10]. The absenceof calcification on CT, normal a fetoprotein, and presence22 Case report1687-4137 c 2014 Annals of Pediatric Surgery DOI: 10.1097/01.XPS.0000438123.47899.f7Copyright © Annals of Pediatric Surgery. Unauthorized reproduction of this article is prohibited.of a normal kidney and adrenals negated the diagnosis ofteratoma, hepatoblastoma, nephroblastoma, and a cysticneuroblastoma [1–9].The recurrence rate for any lipoma after local excision isless than 5% [9]. Incomplete excision and lipoblastoma-tosis are associated with increased chances of recurrence,Fig. 1Contrast-enhanced computed tomography scan: axial and left parasagittal images show a fat attenuation mass (M) anterior to the stomach (S).Fig. 2Intraoperative image taken from the head end showing attachment of mass to spleen, greater curvature of the stomach, and transverse colon from leftto right.Giant omental lipoma Garge et al. 23Copyright © Annals of Pediatric Surgery. Unauthorized reproduction of this article is prohibited.about 14–20% [8]. Despite its rarity, the diagnosis ofomental lipoma can be made preoperatively by a carefulclinical examination and appraisal of the contrast-enhanced CT scan.AcknowledgementsConflicts of interestThere are no conflicts of interest.References1 Luo X, Gao W, Zhan J. Giant omental lipoma in children. J Pediatr Surg2005; 40:734–736.2 Giubilei D, Cicia S, Nardis P. Lipoma of the omentum in a child. Radiology1980; 137:357–358.3 Barauskas V, Malcius D, Jazdauskiene V. Lipoma of the greater omentum ina child. Medicina (Kaunas) 2004; 40:860–863.4 Haller JO, Schneider M, Kasner EG. Sonographic evaluation of mesentericand omental masses in children. Am J Roentgenol 1978; 130:269–274.5 Joulak M, Houas F, Bellagha I, Ben Salah S, Ben Becher S. Radiologic caseof the month. Lipoma of the omentum. Arch Pediatr 1998; 5:669–670.6 Srinivasan KG, Gaikwad A, Ritesh K. Giant omental and mesenteric lipomain an infant. Afr J Paediatr Surg 2009; 6:68–69.7 Abubakar AM, Mayun AA, Pindiga UH, Chinda JY, Adamu SA. Giant omentallipoma in a 13-year-old adolescent girl. J Pediatr Surg 2009; 44:2230–2232.8 Mendez-Gallart R, Estevez-Martinez A, Baustista-Cassasnovas J. Giantomental lipoblastoma in a 10 month old infant composing 20% of total bodyweight. J Pediatr Surg 2007; 42:1149–1152.9 Cascini V, Lisi G, Lauriti G. Giant abdomino-pelvic adipose tumors ofchildhood. Pediatr Surg Int 2012; 28:89–93.10 Tang XB, Zhang T, Bai YZ, Wang WL. Giant mesenteric lipoblastoma in a4-year old child. J Pediatr Surg 2009; 44:859–861.11 Pereira JM, Sirlin CB, Pinto PS, Casola G. CT and MR imaging ofextrahepatic fatty masses of the abdomen and pelvis: techniques, diagnosis,differential diagnosis, and pitfalls. Radiographics 2005; 25:69–85.12 Beattie GC, Irwin ST. Torsion of an omental lipoma presenting as anemergency. Int J Clin Pract Suppl 2005; 147:130–131.13 Prando A, Wallace S, Marins JL, Pereira RM, de Oliveira ER, Alvarenga M.Sonographic features of benign intraperitoneal lipomatous tumors inchildren – report of 4 cases. Pediatr Radiol 1990; 20:571–574.Table 1 Review of literatureReferences Age/sex Weight of tumor Size of tumor Pathology Duration Symptoms Follow-upCascini V et al. [9] 19 months/M 1185 g (12% of body weight) – Lipoblastoma Since birth Abdominal distension,failure to thrive4 yearsAbubakaret al. [7]13 years/F 12.3 kg (30% of body weight) 342422 cm Lipoma 9 years Asymptomatic abdominallump, early satiety4 monthsSrinivasanet al. [6]9 months/notmentioned1.5 kg Not mentioned Lipoma 3 months Abdominal lump, diarrhea Not mentionedMéndez-Gallart Ret al. [8]10 months/F 1480 g (20% of body weight) 171216 cm Lipoblastoma 6 months Asymptomatic abdominallump2 yearsLuo et al. [1] 11 months/M 1.82 kg 121521 cm Lipoma 6 months Abdominal lump 1 yearBarauskaset al. [3]8 years/F Not mentioned 10118 cm Lipoma Acute Abdominal pain, fever,torsion of lipomaNot mentionedJoulaket al. [5]3 years/F Not mentioned 1277 cm Lipoma Not mentioned Abdominal lump Not mentionedPrandoet al. [13]1 year/F Not mentioned 1310 8 cm Lipoblastoma Not mentioned Abdominal lump Not mentionedHaller JO [4] 3 years/F Not mentioned 845 cm Lipoma Not mentioned Abdominal lump Not mentionedThis study 1 year/F 2.0 kg 111113 cm Lipoma 2 months Abdominal lump,early satiety1 year24 Annals of Pediatric Surgery 2014, Vol 10 No 1Copyright © Annals of Pediatric Surgery. Unauthorized reproduction of this article is prohibited.

Giant omental lipoma: Report of a case with review of the literature

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Giant omental lipoma: Report of a case with review of the literature

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