Gastric lipoma presenting as a giant bulging mass in an oligosymptomatic patient: a case report

Abstract

IntroductionLipomas of the gastrointestinal tract are a rare condition. Only 5% are of gastric origin, and this corresponds to 2% to 3% of all benign tumors of the stomach and less than 1% of all gastric neoplasms. It is our purpose to report an unusual presentation of a giant gastric lipoma in an oligosymptomatic patient and highlight the importance of discussing differential diagnosis in this situation. A review of the literature has shown that this is one of the largest gastric lipomas described.Case presentationWe describe a rare case of a benign gastric tumor with uncommon features in a 63-year-old Caucasian woman. She was admitted with abdominal discomfort, nausea, and upper abdominal fullness after eating. The lesion was suspicious of malignancy because of its dimension and central contrast enhancement on computed tomography. Conventional upper digestive endoscopy revealed a large bulging mass in the gastric posterior wall and three ulcerated areas. In this procedure, a technical limitation due to the location of the mass in the submucosa prevented an adequate biopsy from being obtained. The fragments obtained from the ulcers revealed nothing but necrotic mucosa. Our patient underwent a subtotal gastrectomy and D1 lymphadenectomy with a Roux-en-Y reconstruction. Macroscopic findings revealed a 12 × 8 × 6cm mass with a volume of 576cm3, and the histological pattern demonstrated well-differentiated mature adipose tissue surrounded by a fibrous capsule, confirming the diagnosis of gastric submucosal lipoma.ConclusionsGastric lipoma is a rare benign disease that eventually simulates a malignant tumor.

Two cases of rare benign mucosal lesions of the stomach

“…Owing to its rarity, which account for ∼3% of all GI lipomas, there are only a couple of case reports of gastric lipomas in the English literature. Commonest site reported is the antrum whereas lipomas of cardia and pylorus are seen less frequently 2 3. Similar to lipomas in other sites in GI tract, 90% of gastric lipomas are submucosal and the rest are seen in subserosa 4 5.…”

Gastric lipoma and pyloric obstruction in a 51-year-old woman

“…The occurrence of pyloric stenosis was an expected complication of the atypical gastrectomy, because the tumor resection was performed at the antrum, and with a large free surgical margin. Gastric lipomas predominate in people over than 50 years of age 2,5,8,11 , and appear as solitary and asymptomatic masses 5-10 . However, patients with gastric lipomatosis have been reported as an exceeding rare condition 12 . The symptoms depend on localization and size of the tumor and of associated entities 2,7-10 .…”

“…Gastrointestinal lipomas more frequently occur in the colon (60-75%) and the small intestine (up to 31,2%) [1][2][3][4][5][6][7] . Only 5% of them are found in the stomach, which accounts for less than 1% of the gastric tumors, and 2% to 3% of benign tumors of this organ 2,4-10 .…”

“…There are only about 220 cases of gastric lipomas described in the literature 2,5,8 , around 10% are intramural or subserosal, while the vast majority have origin in the submucosa 5,[7][8][9][10] . The etiology of lipoma remains unknown 2,6,8 , and it may constitute an acquired condition or an embryological misplacement 6 . The tumor is constituted by well differentiated adipocytes with a fibrous capsule, and if sectioned it grossly appears as an yellowish tissue 2,3,5,7,10 .…”

“…The tumor is constituted by well differentiated adipocytes with a fibrous capsule, and if sectioned it grossly appears as an yellowish tissue 2,3,5,7,10 . Although more commonly located in the gastric antrum (75%) 2 , these tumors may be found at any site of the stomach [4][5][6][7][8][9][10] . Gastric lipoma is a rare benign condition, which may mimic malignancy of the stomach.…”