Gastric Xanthoma: A Review of the Literature

Abstract

Context: Xanthelasmas, also known as "xanthomas" and "lipid islands" are yellow plaque-like lesions characterized by the presence of lipid-containing histiocytes. Evidence Acquisition: Xanthomas are most commonly found in the stomach within the gastrointestinal tract, and at this location they are called Gastric Xanthoma (GX). Clinical significance of GX is still unknown. It has been suggested that GX could be related to gastric injury. Here we reviewed five decades of studies on GX in the literature. Results: Since, GXs was reported to be associated with potentially serious conditions of the stomach, the whole gastric mucosa should be examined carefully and biopsy should be taken from the lesion during the upper gastrointestinal endoscopy for diagnosis and rulling out gastric malignity. Conclusions: Gastric xanthomas should not be ignored and concomitant conditions should be treated.

Two Cases of Rectal Xanthoma Presenting as Yellowish to Whitish Lesions during Colonoscopy

“…Although cutaneous and tendinous xanthomas occur in relation to hyperlipidemia, gastrointestinal xanthomas are not associated with dyslipidemia [ 3 , 7 , 13 ]. Miliauskas et al reported that, among four cases with colorectal xanthomas, none had hyperlipidemia and only one had diabetes mellitus [ 7 , 8 ].…”

“…The etiology of colorectal xanthomas remains unknown. Xanthomas in the stomach are assumed to arise as an inflammatory response to focal mucosal damage and chronic injury such as chronic gastritis [ 3 , 7 , 14 – 16 ]. The resident macrophages commonly exist in the subepithelial lamina propria of the gastrointestinal tract.…”

“…Although macrophages are not pathologically noticeable in normal gut mucosa, they can be identified when they phagocytize and accumulate exogenous or endogenous substances [ 17 ]. Content of the foamy macrophages in xanthomas is assumed to come from lipids derived from damaged cell membranes [ 3 , 7 , 14 ]. Mucosal damage and chronic injury are believed to be associated with the pathogenesis of colorectal xanthomas [ 7 , 15 ].…”

“…Within the gastrointestinal tract, the stomach is the most frequently affected by xanthoma, whereas other parts such as the esophagus, duodenum [ 2 ], small intestine, and colorectum usually remain unaffected. Macroscopic features of gastric xanthoma are well known as yellow to white well-demarcated plaques or nodules [ 3 ]. Endoscopic images of colorectal xanthoma have rarely been reported in the literature due to their infrequency.…”

Multiple, Large Colonic Xanthomas Presenting as Intestinal Obstruction

“…Under the microscope, xanthomas consist of foamy histiocytes [1]. The most common site of xanthomas in the gastrointestinal (GI) tract is the stomach, predominantly in the antrum and the pyloric region [2]. The esophagus and small intestines are usually spared [3].…”