Gastrointestinal: Gastric lipoma as a rare cause of recurrent gastrointestinal bleeding

Gastrointestinal: Gastric lipoma as a rare cause of recurrent gastrointestinal bleeding A 66‐year‐old male presented to our hospital because of passage of tarry stool. He had a history of diabetes and hypertension. He was not taking an anticoagulant but had recently used non‐steroidal anti‐inflammatory drug for arthralgia. On examination, he appeared pale. Laboratory tests revealed a microcytic anemia (hemoglobin: 11.6 g/dL, mean cell volume: 78.8 fL). Gastroscopy revealed a 4‐cm, slightly yellowish, submucosal tumor with central ulceration (Fig. a) at the gastric antrum with a positive pillow sign (Fig. b). The same lesion had been found during previous endoscopies 2 and 5 years ago, and the patient declined surgical resection. Previous abdominal CT also revealed a well‐defined fat‐containing tumor consistent with a gastric lipoma (Fig. a). Because of recurrent bleeding episodes from the tumor during the past 5 years, the patient consented to endoscopic resection of the tumor (Fig. b). The pathology diagnosed a submucosal lipoma comprising mature fat cells with intervening fibrous tissue.1(a) Upper endoscopy revealed a submucosal tumor with central ulceration. (b) Endoscopic view of a positive pillow sign.2(a) Abdominal CT revealed a well‐defined fat‐containing tumor at gastric antrum (arrow). (b) Endoscopic view of the tumor during endoscopic submucosal dissection.Lipomas are common benign subepithelial lesions in the gastrointestinal tract, most commonly found in the colon followed by the stomach and the small intestine. They are composed of adipose tissue and are generally asymptomatic as an incidental finding during endoscopic or radiological examination. On endoscopy, lipomas often display a yellowish color, and a “pillow sign” can be demonstrated by probing of the tumor with forceps. A CT scan of a gastric lipoma is diagnostic when it shows a well‐circumscribed submucosal mass lesion with fat density. Ultrasound may demonstrate a homogeneous, well‐defined hyperechoic lesion arising from the submucosal layer. Most gastric lipomas have a low risk of malignant change, and neither resection nor surveillance is required for asymptomatic ones. Rarely, complications such as hemorrhage or obstruction may develop from large lipomas, and surgical excision, either by partial gastrectomy or by enucleation, is indicated. With the improvement of endoscopic therapy, endoscopic resection with the unroofing technique or submucosal dissection (endoscopic submucosal dissection), as in this case, can be provided as an alternative treatment. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Gastroenterology and Hepatology Wiley

Gastrointestinal: Gastric lipoma as a rare cause of recurrent gastrointestinal bleeding

Free
1 page
Loading next page...
1 Page
 
/lp/wiley/gastrointestinal-gastric-lipoma-as-a-rare-cause-of-recurrent-eke36D8PtA
Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd
ISSN
0815-9319
eISSN
1440-1746
D.O.I.
10.1111/jgh.13997
Publisher site
See Article on Publisher Site

Abstract

A 66‐year‐old male presented to our hospital because of passage of tarry stool. He had a history of diabetes and hypertension. He was not taking an anticoagulant but had recently used non‐steroidal anti‐inflammatory drug for arthralgia. On examination, he appeared pale. Laboratory tests revealed a microcytic anemia (hemoglobin: 11.6 g/dL, mean cell volume: 78.8 fL). Gastroscopy revealed a 4‐cm, slightly yellowish, submucosal tumor with central ulceration (Fig. a) at the gastric antrum with a positive pillow sign (Fig. b). The same lesion had been found during previous endoscopies 2 and 5 years ago, and the patient declined surgical resection. Previous abdominal CT also revealed a well‐defined fat‐containing tumor consistent with a gastric lipoma (Fig. a). Because of recurrent bleeding episodes from the tumor during the past 5 years, the patient consented to endoscopic resection of the tumor (Fig. b). The pathology diagnosed a submucosal lipoma comprising mature fat cells with intervening fibrous tissue.1(a) Upper endoscopy revealed a submucosal tumor with central ulceration. (b) Endoscopic view of a positive pillow sign.2(a) Abdominal CT revealed a well‐defined fat‐containing tumor at gastric antrum (arrow). (b) Endoscopic view of the tumor during endoscopic submucosal dissection.Lipomas are common benign subepithelial lesions in the gastrointestinal tract, most commonly found in the colon followed by the stomach and the small intestine. They are composed of adipose tissue and are generally asymptomatic as an incidental finding during endoscopic or radiological examination. On endoscopy, lipomas often display a yellowish color, and a “pillow sign” can be demonstrated by probing of the tumor with forceps. A CT scan of a gastric lipoma is diagnostic when it shows a well‐circumscribed submucosal mass lesion with fat density. Ultrasound may demonstrate a homogeneous, well‐defined hyperechoic lesion arising from the submucosal layer. Most gastric lipomas have a low risk of malignant change, and neither resection nor surveillance is required for asymptomatic ones. Rarely, complications such as hemorrhage or obstruction may develop from large lipomas, and surgical excision, either by partial gastrectomy or by enucleation, is indicated. With the improvement of endoscopic therapy, endoscopic resection with the unroofing technique or submucosal dissection (endoscopic submucosal dissection), as in this case, can be provided as an alternative treatment.

Journal

Journal of Gastroenterology and HepatologyWiley

Published: Jan 1, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off