Asymptomatic Giant Gastric Lipoma: What to Do?

Abstract

Gastrointestinal (GI) lipomas are benign, usually single, slowly growing tumors. Their occurrence in the GI tract is most common in the colon, but they can be found also in the small bowel and very rarely in the stomach, where they account for 5% of all GI lipomas. Although most gastric lipomas (GL) are usually detected incidentally, they can cause severe symptoms such as obstruction, invagination, and life-threatening hemorrhages. To date, only three cases of GL have been reported in childhood. We describe the case of an 11-yr-old girl with asymptomatic giant GL, who has not received any treatment until now. New diagnostic insights, therapeutic options, and indications for treatment in asymptomatic patients are discussed.

Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico

“…Se recomienda resección quirúrgica en casos sintomáticos y en lesiones asintomáticas sobre 4 cm por el riesgo de generar complicaciones, pero el manejo definitivo debe adaptarse al contexto de cada paciente. El tratamiento quirúrgico consiste en gastrectomía total o subtotal [13][14][15] . En este caso, se decidió manejo quirúrgico por la presencia de síntomas debido a una obstrucción gástrica antral causada por el tumor.…”

Symptomatic subserosal gastric lipoma successfully treated with enucleation

“…Furthermore, in the subserosal location, it was impossible to reach the neoplasm endoscopically. Despite the fact that CT scan is highly pathognomonic, there are reports suggesting the necessity of verifying specificity and sensibility of nonradiation based imaging systems, such as high resolution transabdominal ultrasound (TAUS) [19] and abdominal magnetic resonance imaging (MRI) [16] . The treatment modalities for gastric lipomas have been changed in parallel with the advances in endoscopic and imaging techniques.…”

“…However, they played a complementary role in offering a description of a soft submucosal oval-shaped mass in gastric antrum, normal overlying mucosa and histopathology findings. A clear-cut endoscopic differentiation between gastric lipomas and other submucosal neoplasm is not feasible, because routine endoscopic gastric biopsies do not reach the submucosal layer [16] . Furthermore, in the subserosal location, it was impossible to reach the neoplasm endoscopically.…”

“…In our case, subserosal lipoma localized in the antrum caused symptoms such as upper abdominal pain, dyspeptic disorders, and vomiting. This location is mainly responsible for dyspeptic and obstructive symptomatology [15,16] . The size of the lesion is correlated with the onset of abdominal disorders [7,10] .…”

“…The treatment modalities for gastric lipomas have been changed in parallel with the advances in endoscopic and imaging techniques. The choice of treatment for gastric lipomas is still controversial [16] . 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] .…”