S3513 A Rare Case of Angiomyolipofibroma

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Introduction: Angiolipofibroma(ALF) is a rare mesenchymal lesion that is typically benign in nature but at times can be concerning for malignancy. Lesions of the gastrointestinal tract (GI) are rare in comparison to epithelial types. Case Description/Methods: 29 yo male with PMHX of ETOH usage (30 beers a day) presented with rectal bleeding and diarrhea for the past year. BP – 121/74 mmhg, HR: 90bpm Labs – ALT: 69U/l, AST: 60 U/L, Hemoglobin 15.4 g/dl On PE: well appearing, in no distress, small palpable lesion in the right anterior lateral portion of the rectum on rectal exam. Ansocopy showed small hypertrophic papillae with internal hemorrhoids. A follow-up colonoscopy showed a 35mm pedunculated polyp (Figure 1) in the recto-sigmoid colon. It was removed with a hot snare and a hemostatic clip was placed without any complications. The area was tattooed in the event of need for further intervention. Pathology revealed a benign reactive hamartoma, identified as either a submucosal ALF or angiolipomas mesenchymal hamartoma. The polyp was re-evaluated and deemed benign polypoid colonic lesion with prominent submucosal vasculature, associated with fibroadipose tissue. It was negative for neoplastic stromal proliferation. He was discharged with repeat colonoscopy in 1 year. Discussion: There are many types of colonic polyps: lipomas, leiomyomas, and hemangiomas. Angiolipomas and ALF are benign tumors of subcutaneous cellular tissue, rarely found in GI tract. They are typically encapsulated, painful, and on the trunk, mostly occurring in those in their mid-thirties. A Hamartoma is a polyp consisting of several tissue types. ALF is an example of a hamartoma, but its extremely rare. Uncommonly, these tumors can be found in the GI tract and can present with abdominal obstruction or a GI bleed, as seen in our patient. To the naked eye they appear well circumscribed and histologically will contain adipose with vascular tissue. Our patient had a rectal bleed, prompting a colonoscopy. He fit the demographic of a young male in his thirties. With the colonoscopy, he was found to have an ALF in the recto-sigmoid area of the colon, which is extreamly rare. There is no official treatment method at this time. Surgical resection during endoscopy is common, which was the therapy used on our patient. We present this case to inform the medical community of this rare finding as ALF rarely present in the GI tract, but once it does, its important to rule out other types of tumors as it can be mistaken for malignancy.Figure 1.: Resected pedunculated polyp on colonoscopy.

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