Gastric lipoma; case report.

Abstract

Since gastric lipoma is rarely diagnosed preoperatively, the following case is considered of interest. Skorneck published a report (3) of a similar example in 1952. Case Report A 50-year-old white female was admitted to Emory University Hospital two weeks following the discovery of a gastric tumor on roentgen examination by her physician. The initial gastrointestinal series was performed because of epigastric pain of eight months duration, which was unrelated to meals. Upon admission to the hospital, no significant abnormalities were discovered on physical examination or on routine laboratory tests. A gastrointestinal series disclosed a large mass in the antrum of the stomach, arising along the greater curvature and measuring about 7 × 9 cm. Within the mass were two large ulcerations, about 1.5 and 2.5 cm. in diameter, respectively. The mass itself was definitely less dense than the adjacent tissues, indicating that it was made up of fatty tissue (Figs. 1 and 2). It was believed to be a submucosal tumor, probably a lipoma or liposarcoma. A subtotal gastrectomy and anterior gastrojejunostomy were performed. Examination of the specimen revealed an ovoid mass, 8 × 6 cm., of soft but slightly elastic consistency. Two ulcer craters measuring 0.8 and 0.7 cm. in diameter, respectively, penetrated to a depth of 8 mm. The mucosa appeared to be edematous over the tumor area, but was not remarkable elsewhere. The tumor was well encapsulated, and easy to shell out, except for two areas of fibrous attachment in the immediate vicinity of the mucosal ulcerations. It was entirely intramural, being covered by 1 to 3 mm. of mucosa and 2 to 3 mm. of the muscular wall along the serosal surface. Microscopic examination confirmed the diagnosis of lipoma of the stomach with mucosal ulcerations. Areas of fat necrosis and fibrosis were also seen. Discussion About 5 per cent of the gastric tumors diagnosed on roentgen examination are benign. The figure based on autopsy diagnoses is slightly higher, since many of the benign lesions are asymptomatic. About 2 per cent or less of all benign gastric tumors are lipomas, a little over 100 cases having been reported. These tumors may be sessile or pedunculated. In the latter instance, they may initiate intussusception or intermittent intestinal obstruction by a ball-valve mechanism. Although the majority of these lipomas are submucosal, they may be predominantly intramural or subserosal. Gastric lipomas are, in rare instances, multiple; they are occasionally associated with lipomas elsewhere. The tumors are seldom large enough to be palpable, generally averaging 4 to 5 cm, in diameter. The antrum is the usual site of involvement. Approximately a third of all lipomas of the stomach have overlying ulcerations. Accurate preoperative diagnosis of the histologic type of a benign gastric tumor is unusual. It has been occasionally reported following gastroscopy with aspiration of tumor material.