A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb: a case report

Lipomas are benign tumors composed of mature adipocytes. Gastrointestinal (GI) lipomas are rare neoplasms, particularly those occurring in the stomach, which account for only 5% of all GI lipomas and 2%–3% of all benign gastric tumors. They are most commonly found in the gastric antrum [1] [2]. Gastric lipomas are typically small and asymptomatic; however, as they enlarge, symptoms such as epigastric discomfort, gastric outlet obstruction, and dyspepsia may occur [3].

We report the case of a 47-year-old man who was referred to our department following the detection of a large submucosal protrusion during an upper GI endoscopy at an external hospital. Esophagogastroduodenoscopy revealed a giant subepithelial lesion ([Fig. 1]). Extensive, thickened, fold-like and nodular mucosal elevations resembling cerebriform changes were observed from the greater curvature of the lower gastric body to the antrum. A prominent protrusion extended into the duodenal bulb through the pylorus, with smooth overlying mucosa and a soft texture. Endoscopic ultrasonography demonstrated that the lesion was primarily located in the submucosa, with localized thickening up to 1.6 cm, exhibiting homogeneous hyperechogenicity. Elastography indicated a soft consistency, consistent with the characteristics of a lipoma. Contrast-enhanced computed tomography revealed nodular and mass-like lesions with fat density in the gastric body, antrum, and adjacent duodenal region, with the largest measuring approximately 7.2 × 5.8 cm, suggestive of a lipoma ([Fig. 2]).

Fig. 1 Endoscopic findings. a Giant cerebriform submucosal lipoma in the gastric body. b Giant cerebriform submucosal lipoma in the gastric antrum.

Fig. 2 Contrast-enhanced computed tomography showed fat-dense nodules.

Endoscopic snare electrocautery resection was performed to remove two large tissue specimens for pathological examination, with no postoperative bleeding observed at the resection site ([Video 1]).

A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb.Video 1

Histopathological examination of the biopsy specimens confirmed the presence of mature adipose tissue in the lamina propria and submucosa, supporting the diagnosis of a lipoma ([Fig. 3]).

Fig. 3 Histological analysis revealed mature fat tissue in the lamina propria and submucosa, diagnostic of lipoma (hematoxylin and eosin ×100).

To our knowledge, this is the first reported case of a giant gastric lipoma exhibiting cerebriform morphology and extending from the gastric body to the duodenal bulb. Although the lesion was extensive, the intact mucosa and absence of malignant features supported a benign diagnosis. Conservative management with regular follow-up may be considered; however, endoscopic resection should be performed if symptoms such as obstruction, bleeding, or ulceration develop [4].

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

 

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Conflict of Interest

The authors declare that they have no conflict of interest.

• 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: 5619
• 2 Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep 2019; 5: 20180109
• 3 Krasniqi AS, Hoxha FT, Bicaj BX. et al. Symptomatic subserosal gastric lipoma successfully treated with enucleation. World J Gastroenterol 2008; 14: 5930
• 4 Deprez PH, Moons LMG, OʼToole D. et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 412-429

Publication History

Article published online:
02 July 2025