Gastrointestinal lipomas are benign, non-epithelial, slowly growing tumors. The majority are located in the colon (60-75%), followed by the small bowel (20-25%). Gastric lipomas (GLs) are rare and usually located in the antrum (1,2).
Case reportWe report the case of a 44-year-old man that was admitted to the emergency department with a history of tiredness and intermittent melena for the previous month. He denied abdominal pain, dyspeptic symptoms, and anorexia or weight loss; there was no intake of non-steroidal anti-inflammatory drugs. Past medical history was significant for arterial hypertension, obesity and sleep apnea syndrome. An esophagogastroduodenoscopy (EGD) performed 5 years earlier was described as normal. Physical examination was unremarkable, except for pallor and obesity (body mass index 34 kg/m 2 ). Laboratory tests showed a decreased hemoglobin (7,8 g/dL); the remaining blood cell count and chemistry profile were within normal limits. Emergency EGD revealed a subepithelial mass at the gastric fundus, approximately 4 cm in diameter, with a central ulceration where a yellowish tissue suggestive of fat was protruding ( Fig. 1) -a lipoma or liposarcoma was suspected. An endoscopic ultrasonography (EUS) was performed, showing a hyperechoic mass within the submucosal layer, mildly heterogeneous at the luminal border (Fig. 2). A computerized tomography (CT) was also performed which revealed a homogeneous mass with fat density in the gastric fundus, with well demarcated margins, with a notch on the side facing the lumen (corresponding to the ulceration saw at EGD); no secondary lesions were present (Fig. 3). The patient was submitted to partial gastric resection (Fig. 4) and was discharged 10 days after the procedure; no incidents were reported. Histological examination confirmed the diagnosis of submucosal lipoma and ulceration of the overlying mucosa (Fig. 5).
Development of effective non-viral vectors is of crucial importance in the implementation of RNA interference in clinical routine. The localized delivery of siRNAs to the gastrointestinal mucosa is highly desired but faces specific problems such as the stability in gastric acidity conditions and the presence of the mucus barrier. CDX2 is a transcription factor critical for intestinal differentiation being involved in the initiation and maintenance of gastrointestinal diseases. Specifically, it is the trigger of gastric intestinal metaplasia which is a precursor lesion of gastric cancer. Its expression is also altered in colorectal cancer, where it may constitute a lineage-survival oncogene. Our main objective was to develop a nanoparticle-delivery system of siRNA targeting CDX2 using modified chitosan as a vector. CDX2 expression was assessed in gastric carcinoma cell lines and nanoparticles behaviour in gastrointestinal mucus was tested in mouse explants. We show that imidazole-modified chitosan and trimethylchitosan/siRNA nanoparticles are able to downregulate CDX2 expression and overpass the gastric mucus layer but not colonic mucus. This system might constitute a potential therapeutic approach to treat CDX2-dependent gastric lesions.
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