International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 122 Case report: A Caecal Lipoma with Pseudomalignant Features and Colo-colonic Intussusception. Fatimah Mastura Ishakˡ and Juhara Haron 2 Abstract Gastrointestinal lipomas are rare benign non-epithelial tumours, usually single and slow growing. Most of colonic lipomas were detected incidentally during surgery, endoscopy or autopsy with incidence ranges from 0.2% to 4.4%. While lesion measures smaller than 2cm in diameter are usually asymptomatic, a larger lesion more than 2cm, can cause symptoms such as intestinal obstruction, rectal bleeding, intussusception, constipation, diarrhea or prolapse. Pre-operative diagnosis is challenging as symptoms and imaging mimic malignancy. Direct visualization of the submucosal lipoma can be done by endoscopy. It is seen as smooth, rounded yellowish polyps with a thick stalk or broad-based attachment. Its typical features are the “tent sign” (elevation of the mucosa over lipoma with biopsy forceps), “cushion sign” or “pillow sign” (pressing forceps against the lesion results in depression or pillowing of the mass) and the “naked fat sign” (extrusion of yellowish fat at the biopsy site). In some cases, with large sized fat shaped lesion and ulceration may lead to an impression of malignant lesion. If the endoscopic biopsy is not taken at accurate site, for example at infamed mucosal of adjacent tissue, it can give false impression of “nonspecifc colitis ” . We describe a patient with persistent diarrhea and hematochezia who underwent open right hemicolectomy for the presumptive endoscopic and imaging diagnosis of caecal adenocarcinoma. However, histological examination confrmed benign caecal lipoma. Keywords: Colonic lipoma, caecal lipoma, benign intestinal tumour. Correspondence to: Assoc. Prof. Juhara Haron, Senior Lecturer, Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. E-mail: drjuhara@usm.my 1. Dr. Fatimah Mastura Ishak, Postgraduate Radiology candidate, Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. 2. Assoc. Prof. Juhara Haron, Senior Lecturer, Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page : 122-126 DOI: http://dx.doi.org/10.31344/ijhhs.v5i1.247 Introduction Gastrointestinal lipomas are rare benign non- epithelial tumours, usually single and slow growing. Most of colonic lipoma usually detected incidentally during surgery, endoscopy or autopsy 1 . Most literatures reported its incidence ranges from 0.2 percent to 4.4 percent 2 .In patient with lesion measures smaller than 2cm in diameter, they are usually asymptomatic. If the intestinal lipoma is larger than 2cm, it can cause symptoms such as intestinal obstruction, rectal bleeding, intussusception, constipation, diarrhea or prolapse. Pre-operative diagnosis is challenging as symptoms and imaging mimic malignancy 3 . Direct visualization of the submucosal lipoma can be done by performing endoscopy. It is seen as smooth, rounded yellowish polyps with a thick stalk or broad-based attachment. Its typical features are a smooth, spherical polyp, usually sessile, slightly yellowish in colour while the overlying mucosa is intact. Other typical features are the “tent sign” (elevation of the mucosa over