Gastric xanthoma – An unusual, near–miss finding in the stomach

Xanthomas are rare benign lesions characterized by an accumulation of foamy lipid-laden macrophages which usually present themselves as yellow – white, well-defined plaques. While the gastrointestinal tract is a highly uncommon site for xanthomas, the stomach tends to be the most frequently affected part. Despite their benign and mostly asymptomatic character, studies show that gastric xanthomas may be considered premalignant lesions and even a predictive marker of early gastric cancer development. We report the case of a 72-year-old man, who presented with significant weight loss, indigestion and iron deficiency anemia. Upon upper endoscopy examination, directly inferior to cardia, we observed an ulcerated, poorly delimited lesion, covered in white detritus, extending to the lesser curvature, which was only visible during retroflexion, for which the pathological report came back as chronic gastritis with incomplete intestinal metaplasia and negative Helicobacter pylori infection, which prompted a proton pump inhibitor treatment. After 2 months, due to persistent high suspicion of gastric malignancy despite the previous pathological report and no significant clinical improvement, another upper endoscopy was performed which showed the same deep, ulcerated lesion, covered in white detritus for which the pathological report came back as gastric xanthoma, with incomplete intestinal metaplasia and negative Helicobacter pylori infection. Considering the unusual aspect of the lesion found in the patient’s stomach which resembles more a malignant lesion rather than a benign one, contradicting therefore the pathological reports, this case begs the question of what further surveillance should look like and the treatment options available [1] [2].

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Shen WN, Qu XD, Chen SS, Liu YH, Gao MJ, Shi YQ.. Relationship between gastric xanthoma, gastric precancerous lesions, and gastric cancer: A retrospective study. J Dig Dis 2023; 24 (5): 340-347 Epub 2023 Jul 2837417403
• 2 Moumin FA, Mohamed AA, Osman AA, Cai J.. Gastric Xanthoma Associated with Gastric Cancer Development: An Updated Review. Can J Gastroenterol Hepatol 2020; 2020: 3578927 PMID: 32149048; PMCID: PMC7054765