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 of Gastroenterology and Hepatology – Wiley
Published: Jan 1, 2018
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