Mesenteric Lipoblastoma and Cervical Lipoblastomatosis: Ultrasound, Elastosonography, and Computed Tomography Findings in Two Children

Lipoblastomas are benign tumors of the embryonic lipoid cells mainly occurring in infancy and early childhood. They are clinicopathologically distinguished in two forms: the well-circumscribed and localized type and the diffuse, irregularly confined type with infiltrative growth pattern, also called lipoblastomatosis. We report two pediatric cases of a mesentery localized and cervical diffuse lipoblastomas investigated both with ultrasound and computed tomography examinations. 1. Introduction Lipoblastoma (LB) is a rare tumor of soft tissues which mainly occurs in infancy and early childhood [1–4]. It is usually located in the soft tissues of the limbs and trunk commonly presenting as a painless mass that can variably grow. Clinicopathologically LBs are distinguished into two benign forms: circumscribed or diffuse (lipoblastomatosis) [1, 2]. Despite its benign biological behavior LB may become symptomatic because of its enlargement and compression to adjacent organs and structures. The best treatment to prevent recurrences is the complete surgical excision [3, 4]. 2. Case Report 2.1. Case 1 A 3-year-old male was brought to our institution suffering from abdominal pain and vomiting. An intra-abdominal painless palpable mass was appreciable and blood tests were normal. Abdomen ultrasonography (US) showed a huge coarse mass of mixed echogenicity in paravertebral region dislocating pancreas and intestinal loops (Figure 1(a)). US color-Doppler evaluation stated a poor intra- and perilesional vascularity while elastosonography revealed mass had a soft consistency appearing green on colorimetric hardness scale (Figure 1(b)). Computed tomography (CT) scan displayed that the mass had adipose densitometry, was capsulated with some septa of soft-tissue attenuation, and extended from subhepatic space to the lower pelvis compressing intestinal loops. After intravenous contrast medium administration, the contrast enhancement was low and mainly appreciable in the septations (Figures 1(c) and 1(d)). The findings suggested a peritoneal lipomatous neoplasm. Child underwent surgery and through histological examination of surgical specimen the diagnosis of mesenteric LB was finally made. Figure 1: (a) US examination revealed mass had mixed echogenicity with some hyperechoic thin septations. (b) The mass appeared mainly green—soft—on elastosonography. ((c), (d)) CT showed the mass had fatty density with a few septations and no contrast enhancement. 2.2. Case 2 A 3-year-old girl underwent neck US at our institution because of a right cervical swelling departing from