3132 Duodenal Spindle Cell Lipoma as a Rare Cause of Upper GI Bleeding

Abstract

INTRODUCTION: Spindle cell lipomas are benign tumors commonly seen arising from subcutaneous tissue. Incidence of duodenal lipoma as a cause of GI bleed is very rare, however spindle cell variant of duodenal lipoma has never been reported per our review. To our knowledge this is the first case of duodenal spindle cell lipoma in an atypical location presenting as upper GI bleed. CASE DESCRIPTION/METHODS: A 68 year old lady with medical history significant for coronary artery disease with stents and GERD came in with complaints of shortness of breath. She also complained of melena and weight loss without any hematemesis or abdominal pain. Vitals were stable. Labs remarkable for Hb 9.9, iron panel suggestive of significant iron deficiency with serum iron of 16, ferritin 17. Endoscopy showed a 5 cm non bleeding submucosal lesion with ulceration which was concerning for GIST and a possible source of chronic bleeding. Mass was not biopsied, however patient later underwent duodenal bulb lesion resection with end to end gastroduodenostomy. Pathology of intestinal resection showed duodenal mucosa with an associated spindle cell lipoma. Immunohistochemical stain of duodenal lesion was positive for S100 and CD34, and immuno-negative for remaining stains (CD117, beta-catenin, and EMA), thus consistent with spindle cell lipoma. On follow up, Hb increased and pt reported clinical improvement. DISCUSSION: Primary GI lymphoma is common in stomach. Small intestine and colonic lymphoma account for 9% and 1% respectively. There have been multiple reports published citing association of lymphoma in IBD patients treated with immunomodulators. Our patient had two stomas (ileostomy and colostomy). Both peristomal biopsies were positive for B cell lymphoma. Peristomal lymphoma has been rarely reported. Parnesh et al. (Case 1) reported a similar case of stomal lymphoma in a patient with history of Ulcerative Colitis. Levecq et al. (Case 2) reported a stromal lymphoma in a patient with transfusion related AIDS who underwent total colectomy and ileostomy for indeterminate colitis. The lymphoma was diagnosed at 20 years (case 1) and 2 years (Case 2) post-stoma formation. Lymphoma should be in the differential of stoma being complicated by peristomal tissue proliferation, fistula and infection.