Gastric lipoma: an unusual cause of dyspeptic symptoms

Nasa, Mukesh; Choksey, Ajay; Phadke, Aniruddha; Sawant, Prabha

doi:10.1136/bcr-2016-215297

Cited by 11 publications

(24 citation statements)

References 21 publications

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“…In 4 (80%) of 5 cases, endoscopic ultrasound (EUS) showed characteristic findings of a lipoma of a hyperechoic, well-localized, submucosal mass, but in one case the findings were atypical[ 17 , 24 , 28 , 31 , 32 ]. EUS is useful to identify the primary wall layer of lipomas[ 22 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

Cappell¹,

Stevens²,

Amin³

2017

WJG

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AIMTo systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases.METHODSLiterature systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.RESULTSGiant gastric lipomas are extremely rare: 32 cases reported since 1980, and 2 diagnosed among 117110 consecutive EGDs. Average patient age = 54.5 ± 17.0 years old (males = 22, females = 10). Maximal lipoma dimension averaged 7.9 cm ± 4.1 cm. Ulcerated mass occurred in 21 patients. Lipoma locations: antrum-17, body-and-antrum-4, antrum-intussuscepting-into-small-intestine-3, body-2, fundus-1, and unspecified-5. Intramural locations included submucosal-22, subserosal-2, and unspecified-8. Presentations included: acute upper gastrointestinal (UGI) bleeding-19, abdominal pain-5, nausea/vomiting-5, and asymptomatic-3. Symptoms among patients with UGI bleeding included: weakness/fatigue-6, abdominal pain-4, nausea/vomiting-4, early-satiety-3, dizziness-2, and other-1. Their hemoglobin on admission averaged 7.5 g/dL ± 2.8 g/dL. Patients with GI bleeding had significantly more frequently ulcers than other patients. EGD was extremely helpful diagnostically (n = 31 patients), based on characteristic endoscopic findings, including yellowish hue, well-demarcated margins, smooth overlying mucosa, and endoscopic cushion, tenting, or naked-fat signs. However, endoscopic mucosal biopsies were mostly non-diagnostic (11 of 12 non-diagnostic). Twenty (95%) of 21 abdominal CTs demonstrated characteristic findings of lipomas, including: well-circumscribed, submucosal, and homogeneous mass with attenuation of fat. Endoscopic-ultrasound showed characteristic findings in 4 (80%) of 5 cases: hyperechoic, well-localized, mass in gastric-wall-layer-3. Transabdominal ultrasound and UGI series were generally less helpful. All 32 patients underwent successful therapy without major complications or mortality, including: laparotomy and full-thickness gastric wall resection of tumor using various surgical reconstructions-26; laparotomy-and-enucleation-2; laparoscopic-transgastric-resection-2; endoscopic-mucosal-resection-1, and other-1. Two new illustrative patients are reported who presented with severe UGI bleeding from giant, ulcerated, gastric lipomas.CONCLUSIONThis systematic review may help standardize the endoscopic and radiologic evaluation and therapy of patients with this syndrome.

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Section: Resultsmentioning

confidence: 99%

Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

Cappell¹,

Stevens²,

Amin³

2017

WJG

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“…Additionally, disabling dyspeptic symptoms have been reported. Hemorrhage is thought to occur secondary to the lipoma’s contact with the opposing wall, producing ulceration and necrosis [3,4].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous resection of a gastric submucosal lipoma in the setting of bariatric surgery: A case report and review of current literature

Agafonoff

Pitt

Max

et al. 2019

International Journal of Surgery Case Reports

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“…Standard biopsies are often non-diagnostic due to the submucosal nature of the mass. The addition of endoscopic ultrasonography allows for the identification of gastric lipoma as a homogeneous, hyperechoic lesion in the typical location of Layer 3, submucosal [ 14 ]. Our patient’s endoscopic examinations were positive for the tenting sign, the cushion sign, and for anatomic location in the submucosa.…”

Section: Presentation Of Casementioning

confidence: 99%

“…Additionally, limited procedures such as tumor enucleation, partial resection or other endoscopic and minimally invasive procedures may be possible with an accurate preoperative diagnosis. However, these procedures are not possible for giant gastric lipoma such as was seen in our patient, due to size [ 14 ].…”

Section: Presentation Of Casementioning

confidence: 99%

Giant symptomatic gastric lipoma: A case report and literature review

Amundson

Straus

Azab

et al. 2018

International Journal of Surgery Case Reports

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HighlightsGastric lipomas may become symptomatic when ≥10 cm, at which point they are classified as giant gastric lipomas.Giant gastric lipomas are extremely rare, with only 6 prior cases reported in the English worldwide literature since 1980.Gastric lipoma density is similar to peripheral fat on CT, −80 to −120 Hounsfield units, which is nearly pathognomonic.Circumferential excision of gastric lipomas with a clear margin of normal tissue is adequate for symptomatic resection.Preservation of gastric continuity via gastrotomy and primary closure avoids complications of gastrojejunostomy.

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Gastric lipoma: an unusual cause of dyspeptic symptoms

Cited by 11 publications

References 21 publications

Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies

Simultaneous resection of a gastric submucosal lipoma in the setting of bariatric surgery: A case report and review of current literature

Giant symptomatic gastric lipoma: A case report and literature review

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