The naked fat sign - 23/08/11
Doi : 10.1016/j.gie.2007.07.030
| Commentary How does one diagnose a lipoma? This case demonstrates the “naked fat sign,” a finding pathognomonic for lipoma described in 1982 by Messer and Waye, in which fat spills out of the lesion after it is biopsied. Before biopsying the putative lipoma, however, the diagnosis might be suspected because of blood vessels that may be seen coursing over its surface, or an orange-red surface that changes to a more yellow color toward the base of the lesion. Furthermore, as the lesion is probed with a closed biopsy forceps, it indents and then springs back to its previous shape when the forceps is withdrawn, the so-called “pillow sign.” Immediately prior to taking the biopsy, the mucosa may be grasped with the forceps and pulled up, the so-called “tenting sign.” On imaging, CT reveals a uniform very low–density circumscribed lesion, with typical Hounsfield values of –90 to –30. On barium enema, a lipoma is a radiolucent lesion but is the only lesion to exhibit a relatively lucent appearance on a water enema. Why should anyone care about the lipoma? Usually lipomas are asymptomatic, but they may ulcerate and bleed, or they may cause colicky abdominal pain because of intussusception. Cutaneous lipomas can be associated with syndromes such as hereditary multiple lipomatosis, Dercum’s disease, Gardner’s syndrome, Madelung’s disease, and HIV. Finally, there are variants of lipomas, such as angiolipomas, neomorphic lipomas, spindle cell lipomas, and adenolipomas… and that is the naked truth. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 67 - N° 1
P. 158-159 - janvier 2008 Retour au numéro
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