Childhood giant omental and mesenteric lipoma

Abstract

Omental and mesenteric lipomas are very rare benign lesions of mature adipose tissue. They are well-defined, noninvasive, and encapsulated masses that can be discovered in asymptomatic patients or may cause variable nonspecific symptoms depending on their size and location. The omental and mesenteric lipoma has confusing features in ultrasound; however, computed tomography and magnetic resonance imaging can well characterize and demarcate these lesions. Though few cases of mesenteric and omental lipomas have been reported in the literature, but because of its large size and childhood presentation, the case we present, can be one of the largest childhood omental and mesenteric lipomas ever reported. A 6-year-old girl presented with slowly progressing abdominal distension and repeated dull abdominal pain for last 4 years. Abdominal and pelvic computed tomography examination revealed a huge mesenteric and omental lipoma that was resected surgically without any complications.

Keywords: Abdominal distension; Lipoma; Mesenteric and omental mass; Pediatric abdominal mass.

Fig. 1

(A) Contrast-enhanced right parasagittal CT section through the abdomen and pelvis shows a huge, well-defined, low density, nonenhancing, intraperitoneal, mass lesion extending from the diaphragm down to pelvis. Note the fibrous septa and a calcified focus (arrow). No evidence of inflammatory reaction or infiltration of surrounding structures. (B) Contrast-enhanced axial CT section through the abdomen and pelvis: The well demarcated, low attenuating mass lesion is compressing the bowel loops rather than infiltrating them (arrows). No extension to the retroperitoneal spaces. The retroperitoneal structures and the bowel loops are displaced posterolateraly (arrows). No evidence of any obstructive compression on gastrointestinal or urinary tract organs.

Fig. 2

Macroscopic view from the cut of the large 4 kilograms tan and gray color glistening surfaced encapsulated moderately firm mass. The cut sections show homogenous yellowish tan soft surfaces.

Fig. 3

Microscopic section of the mass lesion shows tumor composed of large nodules and sheet of mature adipocytes without atypia, separated by thin fibrous bands. Negative for malignancy.