CRITERIA FOR ROENTGEN DIAGNOSIS OF SUBMUCOSAL GASTRIC LIPOMA.

Abstract

A review of the world literature shows that gastric lipoma is infrequent. To date, excluding those in this study, 103 cases have been reported, 56 of them in the English literature. Of tumors of the stomach, less than 5 per cent are benign, and of these 3 per cent are lipomas. Despite their relative rarity, they assume importance because, with the aid of the characteristic feature we are presenting, they can be diagnosed with reasonable certainty by radiologic means. The roentgen criteria of Moore (8) are referred to in nearly all articles reporting cases of gastric lipoma, but are for benign gastric tumors in genera1. They are, therefore, of no aid in the differentiation of lipoma from other benign lesions. Skorneck (13) in 1952, reporting a case of gastric lipoma, refers to a unique roentgen appearance enabling a preoperative diagnosis of lipoma, namely, an area of radiolucency not representing intestinal gas. His was a large lesion, and in our experience and study of the available literature, lipomas of such magnitude are the exception and the finding of radiolucency is rare. The majority of lipomas are relatively small, not of sufficient dimension for translucency on an abdominal film. Culver and Dobrak (4) reported a case in 1950 and pointed out a gliding movement of the filling defect, indicating the submucosal position of most lipomas. Rogers and Adams (12) in 1956 described a case manifesting as a filling defect with two ulcerations. A preoperative diagnosis of lipoma was made because the lesion appeared to be less dense than the adjacent tissues. Fiddian and Parrish (6), on the basis of 4 cases, commented that lipomas were characterized by “globular, smooth, regular, clear, and persistent shadows.” One of their patients showed ulceration. Of the cases reported (1–4; 6–7, 9–11; 14–15) preoperative diagnosis of gastric lipoma by the radiologist was most unusual, occurring only when the rather uncommon finding of an obvious decrease in density was noted. The following cases are presented to illustrate radiological findings which we feel are peculiar to lipoma. Case I: M. R., a 58-year-old woman, was admitted to the hospital in June 1955 with complaints of postmenopausal bleeding. Because admission history revealed food aversions and left upper abdominal pain of several years duration, gastrointestinal studies were ordered. Radiography of the stomach revealed an antral filling defect with a central ulceration, changing shape with peristalsis. Also, the tumor was relatively radiolucent (Fig. 1). At surgery a wedge resection of the middle portion of the greater curvature of the stomach was carried out. The gross pathologic specimen was described as a submucosal fatty tumor 7 cm. in diameter, surmounted in the center by a depressed ulceration 1.5 em, in depth. Surrounding mucosa appeared normal. Microscopic diagnosis: Submucosal lipoma with central ulceration.