Gastric Xanthoma Associated with Gastric Cancer Development: An Updated Review

Abstract

Gastric xanthelasma (GX) is a rare tumor-like lesion customarily found as an incidental finding due to its asymptomatic appearance. Grossly, it is a well-marked yellow-white plaque created in the lamina propria by microscopic clusters of foamy macrophages. Xanthelasma is rarely correlated with gastric hyperplastic polyps; gastric xanthomas are rare benign lesions that appear to be associated with inflammation of the gastric mucosa. Etiopathogenesis is also unclear, but it has been suggested to be involved in chronic gastritis, infection with Helicobacter pylori (H. pylori), diabetes mellitus, and hyperlipidemia. e gastric xanthoma prevalence ranges from 0.23% to 7%. Orth first described the condition in 1887. It has been found that xanthelasmas are associated with chronic gastritis, gastrointestinal anastomosis, intestinal metaplasia, and H. pylori infection. ese lesions predispose patients to gastric cancer conditions. Xanthoma (GX) was reported to be a predictive marker for early gastric cancer. However, the effectiveness of these scores and xanthoma (GX) as predictive markers for early gastric cancer detected after H. pylori eradication remains unknown.

A yellow sign indicating danger ahead

“…The relationship between gastric xanthoma, H. pylori infection and associated chronic gastritis and intestinal metaplasia (as was the case in our patient) has been well established (1,4). Moreover, diabetes mellitus was more frequently found in patients with gastric xanthoma (2). All these factors may play a role in carcinogenesis in the stomach, thus possibly explaining the association between gastric xanthoma and gastric cancer.…”

“…Size varies between 2-10mm and multiple xanthelasmata can be seen. Biopsies should be taken to achieve a histopathological diagnosis and exclude resembling pathology such as Russel body gastritis, early gastric cancer or neuroendocrine tumor (2,3). Moreover, sampling of surrounding mucosa should be done to rule out associated pathology such as H. pylori infection, chronic gastritis and intestinal metaplasia.…”

An Unusual Case of a Gastric Xanthoma: A Case Report

“…This case highlights the necessity of searching for accompanying premalignant lesions when a gastric xanthoma is discovered. The location just below the Z-line is important because it supports the hypothesis that gastric xanthomas can be reactive growths in the setting of inflammation or trauma, given the patient’s Barrett’s esophagus and multiple RFAs [ 2 ]. The patient’s lipid panel makes dyslipidemia a significant risk factor less likely, and H. Pylori was ruled out as a risk factor.…”

“…Gastric xanthomas are rare tumor-like lesions with an incidence ranging from 0.2-0.8%, most commonly occurring in the antral region. While the lesions themselves are generally incidental asymptomatic findings and benign, they frequently occur in mucosa where pathologic changes such as chronic gastritis, Helicobacter pylori (H. pylori ) gastritis, intestinal metaplasia, atrophic gastritis, or gastric ulcers are observed [ 1 , 2 ]. These associations have led to the hypothesis that gastric xanthomas are a healing response to local trauma or inflammation.…”

“…These associations have led to the hypothesis that gastric xanthomas are a healing response to local trauma or inflammation. While immunosuppression has been suggested as a possible risk factor for gastric xanthomas, there has been no cited evidence in the literature about how it might be correlated [ 2 ]. There is emerging evidence that gastric xanthomas could be useful markers for predicting the development and location of early gastric cancer, and they can sometimes also be associated with dyslipidemia [ 2 , 3 ].…”