A Case of Gastric Lipoma Removed by Endoscopic Polypectomy

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64-year-old female was found to have a polypoid lesion in the stomach on periodic X-ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy. The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.     

GASTRIC LIPOMA SUCCESSFULLY REMOVED BY LAPAROSCOPIC INTRAGASTRIC SURGERY

Lipomas are found very rarely in the stomach, where they account for only 3% of benign gastric tumors. Here, we report a case of large gastric lipoma removed successfully by laparoscopic intragastric surgery. A 45‐year‐old woman with no symptoms was incidentally diagnosed with a yellowish submucosal gastric tumor, about 3 cm in diameter, in the prepyloric antrum by upper gastrointestinal endoscopy. Pathological findings of biopsy specimens showed no evidence of malignancy. Computed tomography showed an ovoid and well‐circumscribed intramural mass, measuring 35 mm, which was of fat density. These findings suggested that the tumor was a lipoma that we felt should be treated, because large lipomas can give rise to gastrointestinal bleeding. We performed a laparoscopic intragastric enucleation for this tumor. Postoperatively, the tumor was confirmed pathologically to be a lipoma of the stomach. This laparoscopic procedure for benign non‐epithelial gastric tumors, such as lipomas, presented here is technically feasible, safe, and less stressful for the patient than gastrectomy.     

Symptomatic subserosal gastric lipoma successfully treated with enucleation

Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.     

内镜超声在消化道黏膜下肿瘤诊断与治疗中的价值

目的 评价内镜超声在消化道黏膜下肿瘤的诊断及治疗中的价值.方法 对内镜检查中怀疑黏膜下肿瘤者进行内镜超声检查,根据黏膜下肿瘤的起源层次及性质决定治疗方案,内镜治疗包括内镜下黏膜切除术、黏膜剥离-肿瘤摘除术、高频电切术及硬化治疗.结果 73例良性间质瘤起源于黏膜肌层,7例直肠类癌位于黏膜固有层;脂肪瘤13例、异位胰腺17例、胃底静脉曲张5例、囊肿6例起源于黏膜下层;95例良性间质瘤及21例恶性间质瘤起源于固有肌层,1例类癌侵及固有肌层.61例源于黏膜肌层及8例源于固有肌层的良性间质瘤、8例脂肪瘤、8例异位胰腺及7例类癌经内镜切除,4例囊肿行内镜下穿刺治疗;33例源于固有肌层的良性间质瘤、18例恶性间质瘤、2例脂肪瘤、2例异位胰腺及1例类癌经手术切除.病理符合率为97.97%.结论 超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断,对黏膜下肿瘤治疗方案的选择具有重要的指导意义.     

Endoscopic submucosal dissection of a large colonic lipoma:Report of two cases

A colonic lipoma is a very rare benign tumor that is usually asymptomatic and is found incidentally by colonoscopy.Patients with a large colonic lipoma may present with symptoms such as abdominal pain,bleeding,and colonic obstruction or intussusceptions.We report two patients with large colonic lipomas and symptoms.Standard endoscopic submucosal dissection(ESD) was performed to remove the lipomas instead of conventional surgical bowel resection.No complications were observed during or after the procedure.The tumors were resected en bloc,and the patients were discharged 2 d after ESD with a regular diet.The results indicate that ESD can be applied as safe and effective treatment for a large colonic lipoma.     

Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review

Objectives: Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2?cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD.

Methods: Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms.

Results: We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7?cm ×?3?cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2?cm or larger. The average size of the lipomas was 4?cm (range: 1.2–9?cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported.

Conclusion: Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.     

Giant submucosal lipoma of the cecum: report of a case and review of literature

Lipoma of the colon is a relatively rare benign tumor. A case with intermittent subacute colon obstruction due to a giant lipoma of the cecum is reported. A 51-year-old woman presented with intermittent, abdominal crampy pain in the right upper and lower quadrants, accompanied by alternative episodes of diarrhea and constipation. She had had similar symptoms over the last three months. A double-contrast barium enema showed a large (approx. 7 cm in diameter) polypoid mass occluding the lumen of the cecum and the ascending colon. Colonoscopy revealed a submucosal mass suspected of benign tumor but too large for endoscopic resection. Surgery revealed a hard elongated mass in the right colon, which telescoped into the transverse colon and caused colo-colonic intussusception. Right hemicolectomy was performed and pathology documented a mature, submucosal lipoma of the cecum. Six years after the surgery, the patient has not showed any of the previous symptoms. Along with a review of the literature, the incidence, diagnosis complications and treatment of colonic lipomas are discussed.     

A rare case of gastric lipoma with early gastric cancer

An 84-year-old man was admitted to our hospital with a 1-month history of epigastralgia. Upper gastrointestinal endoscopy revealed gastric cancer and a gastric submucosal tumor (SMT) on the greater curvature of the gastric body. By endoscopic ultrasonography, SMT was demonstrated as a well-circumscribed, smooth-bordered and hypoechoic mass localized in the submucosal layer. Total gastrectomy was performed. The histology of the resected specimen revealed a gastric lipoma and an early gastric cancer widespread to the surface on the lipoma. Two lesions were present in the same lesion, but not linked. We report a rare case of gastric lipoma complicated with early gastric cancer.     

Development of a Submucosal Tumor-like Protrusion at the Site of a Gastric Ulcer during H2-Blocker Treatment—Report of a Case—

Abstract: We studied a patient with a gastric ulcer in which the entire ulcer protruded like a submucosal tumor. Candida albicans was observed in the biopsy specimen taken during treatment with cimetidine; the tumor disappeared after treatment with an antifungal agent, both topically and orally. The patient was a 68-year-old male who had undergone periodical endoscopic examinations of his upper digestive tract although he did not complain of any subjective symptoms. He was admitted to Suma Red Cross Hospital because examination revealed an active ulcer on the greater curvature of the fornix of the stomach. The patient was treated with 800mg/day of cimetidine. After ten days of treatment, endoscopic studies revealed the elevation of the entire ulcer, which grew into a mass resembling a submucosal tumor associated with a bridging fold. A biopsy of the periphery of the ulcer revealed the presence of Candida albicans in the tissue specimen. Endoscopic ultrasonography revealed a tear in the submucosa and an inflammatory picture that extended into the tunica muscularis. The patient was diagnosed as having a Candida-infected gastric ulcer. Concomitant use of topical and oral fungizon resulted in the protuberance settling; it was confirmed that the tumor mass completely disappeared and the ulcer healed after 58 days of treatment.     

Eosinophilic granuloma of the stomach mimicking gastric cancer, report of a case

We report a rare case of eosinophilic granuloma of the stomach mimicking gastric cancer. A 49-year-old man was admitted to our hospital to undergo surgery for gastric tumor. Radiologic and endoscopic examination showed a protruding tumor with a deep ulcer at the anterior wall of the pylorus. Although malignant cells were not histologically confirmed in the biopsy specimens, subtotal gastrectomy with lymphadenectomy was performed because gastric cancer was strongly suspected. The gross appearance of the tumor seemed to be that of a gastric cancer, but the histological diagnosis was eosinophilic granuloma. If submucosal tumor of the stomach is suspected, eosinophilic granuloma should be considered as one of the differential diagnoses. Endoscopic removal of the tumor may be useful to make a precise diagnosis before surgery.     

Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis. A solitary Peutz-Jeghers type polyp of the stomach is rare. We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months. During the hospital treatment course for this patient, endoscopic examination revealed a bulging lesion with a central hole, mucosal ulceration, an asymmetrical wall thickness and a narrowing of the gastric lumen. A gastric biopsy further revealed ulceration with moderate dysplasia. The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm × 3 cm. Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes, all greater than 1 cm. The suspected diagnosis was malignant gastric cancer with lymph node metastases. The other lesion, which measured 2 cm × 2 cm × 1 cm was noted in the submucosa of the jejunum during surgery. The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor. The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer, and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum. This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.     

Submucosal lipomas of the colon

Summary and Conclusions The pertinent data in 12 cases of lipoma of the colon have been presented. Next to adenomatous polyps, lipomas are the most common benign tumors of the colon. The symptoms are inconspicuous until the occurrence of complications, such as ulceration, bleeding, intussusception or obstruction. Submucosal lipomas of the rectum or lower sigmoid present a distinctive proctoscopic appearance, and usually can be removed proctoscopically. Above the proctoscopic level, roentgenologic examination is successful in demonstrating the presence of most lipomas. The radiolucent shadow of a submucosal lipoma is smoothly out-lined, sharply defined, occasionally pedunculated and often distinctive enough to suggest a diagnosis of lipoma. Surgical removal is the only satisfactory treatment.     

Hepatocellular carcinoma with gastric metastasis treated by simultaneous hepatic and gastric resection: report of a case

Hepatocellular carcinoma (HCC) with gastric metastasis is extremely rare. There have been few reports on curative surgical resection for gastric metastasis of HCC. We herein report such a case successfully treated by simultaneous surgical resection. A 73-year-old male was admitted for evaluation and treatment of a liver tumor. Computed tomography showed an exophytic tumor of 170 mm in diameter located in the left lobe of the liver with poor delineation to the gastric wall. Upper gastrointestinal endoscopy revealed a submucosal tumor with ulceration in the antrum of the stomach. With a diagnosis of HCC with invasion to the gastric wall, an en bloc resection was planned, and the patient underwent laparotomy. The patients underwent left hemihepatectomy with partial resection of the stomach for adhesion and distal gastrectomy for the tumor. Pathological examination of the liver tumor revealed poorly differentiated HCC, and pathological diagnosis of the tumor in the submucosal and muscular layer of the stomach was compatible with metastasis from HCC, which was separate from the liver tumor. Therefore, we diagnosed the tumor as HCC with hematogenous gastric metastasis. The patient remains well with no evidence of tumor recurrence as of 13 months after resection.     

A Rare Case of Delayed Perigastric Abscess after Curative Resection of Early Gastric Cancer by Uncomplicated Endoscopic Submucosal Dissection: Successful Treatment with Endoscopic Ultrasound-guided Drainage

A 72-year-old man had undergone uncomplicated endoscopic submucosal dissection (ESD) with en bloc resection of a localized 20-mm IIc lesion in the anterior wall of the gastric angle. Twenty-eight days later, he was re-admitted with epigastric pain of one-week duration. Contrast-enhanced computed tomography (CT) revealed a 60-mm mass bordered by viscera; repeat endoscopy confirmed a smooth elevated submucosal tumor at the greater curvature on the oral side of the post-ESD ulcer. We diagnosed him with a perigastric abscess as a complication of ESD and performed endoscopic ultrasound-guided drainage. Subsequently, the symptoms and blood inflammatory parameters improved, and follow-up CT showed the disappearance of the abscess.     

Gastric calcifying fibrous tumor removed by endoscopic submucosal dissection

The World Health Organization describes calcifying fibrous tumors(CFTs) as rare, benign lesions characterized by hypocellular, densely hyalinized collagenization with lymphoplasmacytic infiltration. These tumors rarely involve the gastrointestinal(GI) tract. A routine endoscopic upper gastrointestinal screen detected a 10-mm submucosal tumor(SMT) in the lesser curvature of the lower corpus of the stomach of an apparently healthy, 37-year-old woman with no history of Helicobacter pylori infection. Endoscopic ultrasonography(EUS) localized the internally isoechoic, homogeneous SMT mainly within the submucosa. Malignancy was ruled out using endoscopic submucosal dissection(ESD). A pathological examination confirmed complete resection of the SMT, and defined a hypocellular, spindle-cell tumor with a densely hyalinized, collagenous matrix, scattered lymphoplasmacytic aggregates as well as a few psammomatous, dystrophic calcified foci. The mass was immunohistochemically positive for vimentin and negative for CD117(c-kit protein), CD34, desmin, smooth muscle actin(SMA) and S100. Therefore, the histological findings were characteristic of a CFT. To date, CFT resection by ESD has not been described. This is the first case report of a gastric calcifying fibrous tumor being completely resected by ESD after endoscopic ultrasonography.     

Multiple gastric lipomas

A patient with gastric ulceration and hemorrhage due to multiple antral gastric submucosal lipomas is presented. The number and close apposition of the lipomas resulted in loss of the usual gastroscopic and radiologic findings associated with these benign tumors. Complications arising from both singly occurring and multiple gastric lipomas are discussed.     

Malignant Paraganglioma of the Stomach

Abstract: We report a case of malignant paraganglioma of the stomach. A gastric endoscopic examination on a 67-year-old female, performed for follow-up purposes, revealed an irregularly elevated lesion with a central ulcer on the lesser curvature of the lower body. The lesion showed characteristics of both an epithelial tumor and a submucosal tumor by endoscopy and radiography. The biopsy specimen suggested that the lesion was a malignant poorly differentiated tumor. On abdominal ultrasonography and computed tomography, several space occupying lesions were found in both lobes of the liver. Therefore, this case was diagnosed as having an advanced gastric cancer with liver metastases and underwent distal gastrectomy. Postoperatively, a final diagnosis of gastric paraganglioma was made by histological and immunohistochemical findings (positive for Grimelius, neuron specific enolase and other stains). These findings also revealed lymph node metastases. To date, only seven cases of gastric paraganglioma have been reported. Furthermore, two cases of malignant gastric paraganglioma have also been described in the literature. This is the first case of malignant gastric paraganglioma evaluated in detail by endoscopic and radiographic examinations.     

超声微探头在上消化道黏膜下隆起性病变中的诊断和指导治疗方式价值

目的探讨超声微探头在上消化道黏膜下隆起性病变中的诊断和治疗价值。方法对胃镜检查发现隆起性病变91例患者进行超声微探头检查,根据超声胃镜图像特点选择治疗方案;并对部分内镜治疗或手术切除病例进行超声微探头复查。结果发现外压性改变5例,黏膜下肿瘤86例,包括良性间质瘤50例,恶性间质瘤3例,浸润性癌5例,胃或食管癌手术后吻合口隆起8例,胃淋巴瘤1例,胃黏膜皱襞肥大2例,Brunner腺增生1例,脂肪瘤2例,异位胰腺2例,孤立性静脉瘤7例,静脉曲张4例,囊肿1例。28例黏膜肌层良性间质瘤和2例黏膜下层脂肪瘤采用胃镜下高频电凝切除,11例黏膜肌层间质瘤术后6个月超声微探头复查有3例在原切除部位见到残留的瘤体,胃或食管癌手术后吻合口隆起8例中4例复发并经病理学证实。结论超声微探头能显示黏膜下隆起病变的层次和性质,有利于治疗方案的选择和对治疗效果的评价,从而提高胃镜医师的诊断水平。     

Successful endosocpic submucosal dissection for esophageal squamous cell carcinoma together with a lipoma

Superficial carcinomas over submucosal tumors of the esophagus have seldom been detected. Esophageal lipomas are very rare and only a few cases have been reported. We describe the case of a 73-year-old man with superficial squamous cell carcinoma overlying a lipoma. We successfully performed en bloc resection by endoscopic submucosal dissection (ESD) using the IT-knife. Histological examination showed curative resections. In such cases, ESD may be a promising tool to perform less invasive treatment.     

A CASE OF DUODENAL LIPOMA REMOVED BY ENDOSCOPIC POLYPECTOMY

A rare case of duodenal lipoma removed by endoscopic polypectomy is presented herein. A 64‐year‐old female was found to have a polypoid lesion in the duodenum on gastrointestinal endoscopic examination. Endoscopy revealed a submucosal tumor located on the second portion. Endoscopic ultrasonography (EUS) demonstrated a homogenous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because of the likelihood of the tumor ultimately causing obstruction or bleeding, endoscopic polypectomy was performed. There were no complications after treatment.