Colonic lipomas are benign masses typically found incidentally during routine screening exams. They rarely grow large enough to become symptomatic. While most colonic lipomas are small and do not lead to complications, giant lipomas can present with symptoms ranging from changes in bowel patterns and mild abdominal pain to bowel obstruction. Ulcerated giant colonic lipomas are even more rare findings on screening colonoscopies. Diagnosis in this context can be challenging, and resection is warranted in most cases. Here, we describe an asymptomatic patient who presented for a screening colonoscopy and was found to have a giant ulcerated colonic lipoma.

A granulocytic sarcoma is an unusual tumor outside of bone marrow. It is composed of immature cells of the granulocytic cell line. We present a rare case of a 76-year-old male with a history of myelodysplastic syndrome who presented with a large bowel obstruction secondary to lesions at the cecum and transverse colon. He underwent exploratory laparotomy with extended right hemicolectomy. A pathological examination confirmed a granulocytic sarcoma as the cause of the obstruction.

Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2-6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed. Pathology demonstrated spindle cell neoplasm arranged in short fascicles that were strongly and diffusely positive for S100. An elderly female was found to have a submucosal lesion on surveillance colonoscopy in the proximal transverse colon. Biopsy with jumbo forceps revealed spindle cell neoplasm positive for S100. Patient underwent an uncomplicated limited non-oncologic segmental transverse colectomy. We report only the ninth case of left and sixth in the transverse colon described in the literature. As is true for other mesenchymal tumors, mucosal biopsy is usually inconclusive and deep biopsy or submucosal resection is required, making pre-operative surgical decision difficult.

Ischemic colitis, a potentially reversible pathology of the colon, can masquerade in its presentation as colonic carcinoma. It typically presents with cramping abdominal pain, diarrhea, and per-rectal bleeding. Colonoscopy remains the diagnostic modality of choice that typically shows friable, edematous, or erythematous mucosa with scattered hemorrhagic erosions or ulcerations. Although rare, the colonoscopic findings can sometimes reveal a tumor mass that confounds the diagnosis of ischemic colitis as colonic carcinoma. Our patient was a 78-year-old female with no previous colon cancer screening who presented with a mass-forming variant of ischemic colitis. Due to the overlap in presentations, radiographic findings, and colonoscopic findings, the diagnostic challenge was evident. Ultimately, colon cancer was ruled out through thorough colonoscopic follow-up and biopsy-guided pathological analysis. This case signifies the importance of considering colonic mass as a guise of underlying ischemic colitis to ensure an accurate diagnosis and the best possible outcome for the patient.

BACKGROUND: Leser-Trelat sign is a rare paraneoplastic syndrome in which one main characteristic presented is an eruption of multiple seborrheic keratoses around different areas of the body. This syndrome has been associated with multiple gastrointestinal malignancies, especially adenocarcinoma of stomach and colon.
METHODS: We report a 70-year-old male who presented to the surgery clinic complaining of a persistent lower abdominal pain for the past 2 months. The pain was associated with weight loss and the gradual appearance of multiple seborrheic keratoses in his body. The patient was admitted to the hospital for further evaluation, a CT scan shows an 8.1 × 5.2 cm mass in the mid mesentery and laboratories shows anemia and positive fecal occult blood. The patient was scheduled for an exploratory laparotomy. During the surgery, a large mass was found arising from the ascending colon with invasion into the adjacent sigmoid colon. The mass was sent to pathology and shows a foreign body granuloma. In addition to the surgery, the patient undergoes an endoscopic evaluation to rule out a malignancy from the upper gastrointestinal system, no masses or lesions were found.
CONCLUSIONS: This is the first case reported, as far as our knowledge, of a foreign body granuloma in the association of Leser-Trelat sign. Foreign body granulomas are associated with multiple cellular signaling and this could be the source of the association of the Leser-Trelat sign. Further evaluation is needed to have a better understanding of the association between the Leser-Trelat sign and the formation of a foreign body granuloma.

Systemic mastocytosis (SM) is a heterogeneous disease that often involves the gastrointestinal (GI) tract. Activation and accumulation of mast cells in GI organs can result in symptoms of abdominal pain, nausea and diarrhea along with organ damage with more aggressive disease. Mast cell degranulation can also result in anaphylactic reactions, which can be life-threatening. Recognition of GI manifestations is important for gastroenterologists to aid in diagnosis and management when GI involvement is suspected. Edema, small nodules, urticarial lesions and occasionally ulceration in the small bowel and colon are the most commonly described endoscopic findings. Here we describe a case of SM presenting as a large colonic mass and provide a brief review of the literature on GI involvement of SM.

NSAIDs (non-steroidal anti-inflammatory drugs) are one of the most used medications worldwide. Every day they are used by more than 30 million Americans. Here, we report a rare and interesting case of a 63-year-old woman with a history of NSAID use who presented to our emergency room with lower abdominal pain. Computed tomography (CT) scan of the abdomen with intravenous contrast revealed focal mucosal thickening in the cecum which was highly suspicious for colonic malignancy. She had a colonoscopy which showed two masses and ulcers in the right colon, pathology was negative for malignancy and showed inflammation consistent with NSAID colopathy.

Fecal retention in the blind loop of end to side colonic anastomosis can lead to fecaloma without significant colonic distension. Imaging study and colonoscopy examination can assist in making a definite diagnosis. Revision surgery is the last choice when colonoscopic extraction fails.