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

Abstract

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.

Lipoma Gástrico. Lesión Submucosa Infrecuente. Reporte de Dos Casos Tratados

“…Desde el punto de vista endoscópico, suele verse como una masa submucosa, con o sin ulceración, lo que da la apariencia de "ojo de toro". También se pueden manifestar mediante los denominados signos de "tienda de campaña", "del gordo desnudo", y del "cojín" (Thompson et al, 2003;Kimura et al, 2005;Cappell et al). Sin embargo, el diagnóstico diferencial con otras masas submucosas del estómago, como aquellas formadas por tejido muscular, nervioso, neuroendocrino; o por tumores estromales como los GIST; puede ser difícil (Kim et al, 2011).…”

“…Los lipomas gastrointestinales se observan principalmente en el yeyuno, íleon y colon. La localización gástrica de un lipoma, constituye una rareza; tanto así que, existe evidencia que representaría sólo el 5 % de los lipomas gastrointestinales y menos del 1 % de la totalidad de tumores gástricos (Cappell et al, 2017;Chagarlamudi et al, 2018). Los lipomas gástricos (LG), se localizan habitualmente en la submucosa; aunque puede surgir también de la capa subserosa o intramural (Cappell et al).…”

Gastrointestinal bleeding as an initial manifestation of gastric lipoma: Case report and review of the literature

“…1,2 In a series of 32 patients with giant gastric lipoma, the main risk factor of bleeding was an F I G U R E 1 Endoscopic view: submucosal antral lesion of 4 cm F I G U R E 2 CT scan: The tumor is hypodense and heterogeneous ulcer overlying the lipoma. 6 The lipoma can ulcer because of venous stasis, friction, and trauma of the lipoma against the contralateral gastric wall. 6 When it is complicated, the lipoma must be resected.…”

“…6 The lipoma can ulcer because of venous stasis, friction, and trauma of the lipoma against the contralateral gastric wall. 6 When it is complicated, the lipoma must be resected. Classically, it is a surgical excision: partial gastrectomy or enucleation.…”

“…1,2,6,[13][14][15] The mean size of the lesion was 6.8 cm. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Eleven patients underwent surgical resection, and 5 patients underwent endoscopic resection. This current literature review is limited by the paucity of the literature, which is mainly based on single case reports that were reported retrospectively.…”