This 64 year old man underwent a colonoscopy for mild iron deficiency anemia. Several small rectal polyps were identified and removed. In the region of the splenic flexure, this pedunculated polyp mass was encountered. The mass has a yellowish pale hue is soft on probing with a blunt instrument. This is the classic cushion sign of a lipoma. Gastrointestinal lipomas are composed well differentiated adipose tissue that originates in the submucosa. Usually an incidental finding, these lesions can rarely cause bleeding or obstruction. Because they are highly vascular, asymptomatic lipomas should not be removed by snare cautery due to an excessive post-polypectomy bleeding risk. Lipomas do not present a risk for malignant degeneration. On EUS , their hypoechoic appearance is diagnostic.
Peter B. Kelsey, M.D., Harvard Medical School, Massachusetts General Hospital