Submucosal lipoma of the large intestine masquerading as a colonic malignancy

Lipomas of the alimentary tract are rare tumours that can mimic malignant lesions. They are often small and asymptomatic although larger tumours can present with intusussception or as abdominal masses. We present a case of a transverse colon submucosal lipoma masquerading as a colonic adenocarcinoma leading to resection. A 74 year-old-man was referred urgently for assessment with altered bowel habits, and lower abdominal discomfort along with a positive Faecal-Occult-Blood sample. Colonoscopy demonstrated a large polypoidal lesion at the hepatic flexure with ulceration. Biopsies were inconclusive. A staging CT scan confirmed a 3.3 x 4.3 x 3.4cm Polyp with colonic wall thickening suspicious of malignancy. An extended right hemi-colectomy was performed. Histology showed a large submucosal lipoma with 12 reactive lymph nodes. Colonic lipoma often present as incidental findings detected on either imaging or endoscopically whilst investigating other symptoms. Their appearances can mimic colonic malignancy and surgical resection may be required.