1467 Are Those Really Xanthomas?

Abstract

INTRODUCTION: GI xanthomas are benign mucosal neoplasms consisting of foamy histiocytes. Xanthomas most frequently involve the stomach and usually spare other parts of the GI tract. Gastric xanthomas are well known as yellow to white well-demarcated plaques generally noted after gastrectomy. There is varying association of hyperlipidemia with GI tract xanthomas. Colorectal xanthomas are a rare entity when compared with gastric and esophageal xanthomas and their true incidence rates are unknown. CASE DESCRIPTION/METHODS: An 89-year-old lady with past medical history of short gut syndrome secondary to partial colectomy presented to the hospital with nausea and vomiting. Upon presentation, her vitals were stable. On examination, her abdomen appeared distended. Lab work was notable for sodium of 120. CT scan of the abdomen revealed marked wall thickening of the rectosigmoid colon consistent with colitis. Gastroenterology was consulted for further evaluation. Patient's electrolyte abnormalities were attributed to fluid loss secondary to vomiting. She underwent an EGD which was normal and a sigmoidoscopy which revealed multiple submucosal masses in the rectum and distal sigmoid. Biopsy specimens taken from the rectosigmoid colon revealed xanthomatous mucosal changes without any evidence of malignancy or inflammation. A fasting lipid panel was within normal limits. Patient's vomiting and electrolyte abnormalities resolved with bowel rest and IV fluids. She was able to tolerate advancement in diet and was therefore discharged home with follow up in as an out patient with Gastroenterology. Review of patient's chart revealed four previous visits in the last 3 years to the hospital for nausea, vomiting and abdominal distension. During each visit, imaging was significant for colitis and colonoscopy revealed sigmoid masses proven to be xanthomas on histopathology. DISCUSSION: Majority of the cases of colorectal xanthomas are incidental findings on elective colonoscopies and usually don't present with upper or lower GI symptoms. They typically appear as whitish to yellowish plaques or papules. Our case presentation is unusual in that our patient presented with recurrent symptoms and signs of gastrointestinal tract obstruction such as vomiting and abdominal distension and imaging consistent with colitis without other obvious etiologies. Furthermore, colonoscopy revealed submucosal mass-like xanthomas rather than plaques or papules.