A Rare Case of Gastric Lipoma with Early Gastric Cancer

Abstract

An 84-year-old man was admitted to our hospital with a 1-month history of epigastralgia. Upper gastrointestinal endoscopy revealed gastric cancer and a gastric submucosal tumor (SMT) on the greater curvature of the gastric body. By endoscopic ultrasonography, SMT was demonstrated as a well-circumscribed, smooth-bordered and hypoechoic mass localized in the submucosal layer. Total gastrectomy was performed. The histology of the resected specimen revealed a gastric lipoma and an early gastric cancer widespread to the surface on the lipoma. Two lesions were present in the same lesion, but not linked. We report a rare case of gastric lipoma complicated with early gastric cancer.

Gastric lipoma

“…The specificity of both examinations can be reduced in case of tumor necrosis or ulceration, which can mask the lipomatous characteristics [7]. Gastric lipoma is a benign tumor without malignant potential; however, malignant lesions can be associated [8]. Indeed, the local chronic inflammation or repeated ulcerations of the gastric mucosa caused by large lipoma, could promote gastric cancer [8].…”

“…Gastric lipoma is a benign tumor without malignant potential; however, malignant lesions can be associated [8]. Indeed, the local chronic inflammation or repeated ulcerations of the gastric mucosa caused by large lipoma, could promote gastric cancer [8]. A complete preoperative exploration is necessary, so as not overlook synchronous gastric cancer.…”

Symptomatic subserosal gastric lipoma successfully treated with enucleation

“…However, CT scan is not accurate in determining the layer of location in the gastric wall. Although endoscopic sonography (EUS) provides more accurate findings of submucosal tumors regarding their shape, size and location inside gastric walls [18] , because of limited resources in our hospital, this technique is not available. Upper GI tract endoscopy and biopsies were performed twice for our case.…”

“…It was reported that different surgical and endoscopic procedures have been used in treatment of submucosal lipomas, but more accurate diagnosis preoperatively enable the replacement of previously used resection methods [6,9] by limited procedures such as tumor enucleation, partial resection or other endoscopic and minimally invasive procedures [4,7,10,11,20] . Although there are no malignant transfor mations of a gastric lipoma, coincidental separated malignant lesions have been reported [18] . As it was discussed by Yamamoto et al [18] in 2004, submucosal lipomas that have extended into the gastric lumen may provoke repeat erosions or local inflammation of gastric epithelium, which is thought to promote gastric cancer.…”

“…Although there are no malignant transfor mations of a gastric lipoma, coincidental separated malignant lesions have been reported [18] . As it was discussed by Yamamoto et al [18] in 2004, submucosal lipomas that have extended into the gastric lumen may provoke repeat erosions or local inflammation of gastric epithelium, which is thought to promote gastric cancer. Therefore, complete pretreatment diagnostic evaluation is needed.…”