# A Large Sigmoid Pseudo-Pedunculated Lipoma Mimicking an Adenoma: A Report of a Rare Case and Literature Review

## TL;DR

A large colonic lipoma can look like an adenoma during colonoscopy and can be safely removed endoscopically.

## Contribution

Describes a rare case of a large pseudo-pedunculated lipoma and reviews its diagnostic and therapeutic challenges.

## Key findings

- Large lipomas can mimic adenomas during colonoscopy, causing diagnostic confusion.
- Endoscopic removal is a safe and effective treatment for large, symptomatic lipomas.
- Care must be taken during endoscopic resection to avoid complications like perforation.

## Abstract

Large colonic lipomas exceeding 2.0 cm in size may rarely mimic colorectal adenomas and hence we referred to such lipomas as pseudo-pedunculated lipomas. They can exhibit surface erosions, fissure ulcerations, and mucosal erythema and can pose diagnostic dilemmas during colonoscopy. Our patient presented with iron deficiency anaemia and a positive faecal immunochemical test, a rare but recognised presentation of pseudo-pedunculated lipomas. Available advanced and refined procedures made endoscopic removal of large and even giant, symptomatic, pedunculated lipomas safe and should be the standard of care, while surgical intervention is rarely necessary. Nonetheless, utmost care must be exercised during endoscopic resection due to the high current needed to snare such large lesions to avoid deep thermal injury and perforation. Our case showed that large lipomas can be misinterpreted during endoscopy as adenomas. In experienced hands, endoscopic removal is safe and attainable.