A case of lymphoangioma of the colon with overlapping tubular adenoma

A 78-year-old male was admitted to our hospital for the evaluation of hypergammaglobulinemia. He was diagnosed as having Monoclonal gammopathy of undetermined significance (MGUS), after the examinations. Barium enema and colonoscopy for surveillance to detect amyloidosis, related complication of the MUGS, revealed a 3.0cm × 3.0cm sized sub-mucosal tumor (SMT) with positive cushion sign. Its mucosal surface was diffusely covered with slightly protruded, lobulated mucosa in the transverse colon. Tubular adenoma was detected from a biopsy specimen of overlaid lesion. Endoscopic ultrasonography (EUS) of the SMT demonstrated multiple anechoic, cyst-like patterns, located predominantly in the 3rd layer and thickening of the 1^st, 2^nd layer on which lesion adenoma were overlayed. Based on these findings, they were thought to be colon lymphoangioma overlapping colonic adenoma as a preoperative diagnosis. Laparoscopic excision was performed and histopathologic evaluation of the resected specimen confirmed a tubular adenoma overlying a lymphoangioma. As endoscopic examination has become more widespread, colonic lymphoangioma have increasingly been reported. However, this case is considered an extremely rare case from reviewing literature, and EUS was thought to be very useful for the diagnosis of the lymphoangioma, even if colonic adenoma is overlying.