Gastric lipomatosis treated by total gastrectomy: a case report

Abstract

BackgroundGastric lipomatosis is characterized by multiple gastric lipomas or a diffuse gastric infiltration of the submucosal or subserosal layer by the adipose tissue; diffuse-type gastric lipomatosis is an extremely rare condition. Here, we present the case of a patient with gastric lipomatosis treated by total gastrectomy.Case presentationA 54-year-old man diagnosed with gastric submucosal tumor in 2008 was referred to our hospital for further examination and treatment in September 2016. Upper gastrointestinal endoscopy revealed a submucosal tumor with an associated ulcer on the anterior wall of the lower body of the stomach. A compressing mass was observed on the anterior wall of the greater curvature and the posterior wall of the stomach. Following a biopsy of the submucosal tumor and ulcer, lipoma without malignancy was diagnosed by microscopy. A giant gastric lipoma was suspected because endoscopic ultrasound revealed a high-echoic lesion on the antral wall that extended to the stomach. Therefore, total gastrectomy was performed, and gastric lipomatosis was confirmed by a histological examination of the resected specimen.ConclusionsSurgical treatment is a highly effective treatment for symptomatic gastric lipomatosis with extensive involvement or multiple lipomas and can be used for patient diagnosis.

Non surgical management for massive gastric lipomatosis

“…However, gastric lipomatosis is a rare condition, with only ten previously reported cases in the scientific literature. The present report describe the case of gastric lipomatosis managed with non surgical approach with optimal clinical results [[1], [2], [3], [4]]. This work has been reported in line with the SCARE criteria [21].…”

Gastric lipomatosis

“…The prevalence of gastrointestinal lipoma is reported to range from 0.2 to 5.8% [2]. Gastric lipomas are rare, accounting only for 5% of all gastrointestinal tract lipomas and less than 1-3% of all gastric tumors [3]. A diffuse pattern of submucosal adipose tissue accumulation is even a less common phenomenon than multiple encapsulated lesions [1].…”

“…The submucosal layer, which physiologically consists of loose connective tissue containing numerous elastic fibers [5], is the most common location within the stomach. Approximately 90-95% of all lipomas are submucosal lesions [3].…”

“…Gastrointestinal lesions occur predominantly in the large intestine (64,3%), decreasing in prevalence in the small bowel, stomach and esophagus [2]. Most gastric lipomas are small (4-9 cm in dimension) [3]. The gastrointestinal lesions are likely to ulcerate, become necrotic and inflamed, undergo cystic degeneration, and infrequently present some calcific change [4].…”

“…This may lead to acute, and sometimes severe, upper gastrointestinal hemorrhage. Microcytic hypochromic anemia was reported as the primary indicator of large gastric lipoma [3].…”