Surgery, Gastroenterology and Oncology
Vol. 28, No. 3, Sept 2023
A Giant Gastric Lipoma
Ana Isabel Oliveira, Vítor Neves Lopes, José Pedro Barbosa, Elisabete Barbosa, José Barbosa
Video Case Report, Sept 2023
Article DOI: 10.21614/sgo-577


Introduction: Gastric lipomas are rare (<1% of all gastric tumors). Giant gastric lipomas (³4 cm) are even rare, with only 32 cases described since 1980, of which only 6 with ³10 cm. They are more common in the gastric antrum. The initial manifestation of these tumors may include obstruction, ulceration or gastrointestinal bleeding.


Case Report: We present a clinical case of a woman, 59 years old, with a history of papillary thyroid carcinoma with cervical metastases, asymptomatic. During the follow-up of the carcinoma, a large lipomatous formation was detected in the lesser curvature of the stomach, well circumscribed, in the submucosa. A complementary study was carried out with upper digestive endoscopy (UDE) and ecoendoscopy. The UDE confirmed a lesion on the lesser curvature, covered by normal mucosa, raising suspicion of a gastrointestinal stromal tumor (GIST) or lipoma. However, the biopsy of the lesion did not reveal signs of malignancy. The patient was then proposed for surgery. The patient underwent laparoscopic surgery for extramucosal enucleation of a gastric lipoma measuring 8.5 cm, with resection of the adherent mucosa. The postoperative period was uneventful, with discharge on the 5th day. The anatomopathological examination revealed that it was a well-differentiated lipomatous tumor, negative for the MDM2 gene.


Conclusions: A gastric lipoma must be characterized by CT and UDE. Differential diagnoses include benign lesions such as angiolipomas and fibrolipomas, or malignant ones. In the presence of ulcers or fibrovascular septa, the cytogenetic study is important to exclude liposarcoma. Endoscopic biopsies are usually non-diagnostic due to the submucosal location of the mass. Resection of the lipoma and its' fibrous capsule may be feasible, with the eventual need for subtotal gastrectomy in case of larger lipomas. Local recurrence is <5%, occurring mainly if incomplete excision of the fibrous capsule. Surgery is therefore a valid and safe treatment optioncommon in the gastric antrum. The initial manifestation of these tumors may include obstruction, ulceration or gastrointestinal bleeding.

 


Conflict of interest

All authors declare that they have no conflict of interest.

 

Funding

No funding sources.

 

Ethical statement

Written informed consent was obtained from the patient of this case report.

 

REFERENCES

1. Cappell MS, Stevens CE, Amin M. Systematic review of giant gastric lipomas reported since 1980 and report of two new cases in a review of 117110 esophagogastroduodenoscopies. World J Gastroenterol. 2017;23(30):5619-5633.

2. Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep. 2019;5(2): 20180109.

3. Sabbah M, Nakhli A, Helal I, Bellil N, Ouakaa A, Gargouri D. Gastrointestinal bleeding as an initial manifestation of gastric lipoma: Case report and review of the literature. Clin Case Rep. 2020; 8(10):1988-1992.



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ISSN: 2559 - 723X (print)

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Journal Abbreviation: Surg. Gastroenterol. Oncol.

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