S3088 A Rare Case of Xanthoma Presenting as Gastric Nodule

Abstract

Introduction: Xanthomas are lesions characterized by the presence of lipids containing histiocytes.They are usually found on skin and in mucosal layers. GI xanthomas are benign, well demarcated mucosal lesions, most commonly found in the stomach. We present a case of gastric xanthoma diagnosed in an elderly lady as an incidental finding. Case Description/Methods: A 67 y.o. Female with PMH of hiatal hernia, DM, HTN presents to the ER with complaints of intractable nausea, vomiting and abdominal pain. She has had multiple admissions in the past due to the same complaints which resolve on IV PPI and antiemetics. She also had a CT scan of the abdomen done in the past which showed Hiatal hernia and her EGD done a few months ago showed distal esophageal thickening and gastritis. Due to her recurring symptoms she had a repeat EGD done during this hospital admission which showed presence of non obstructing ring in GE junction, generalized erythematous mucosa in the stomach and nodule with central depression measuring 5 mm present in the cardia. Cold forceps biopsy was taken and sent for pathology. Pathology revealed the presence of gastric xanthoma. Patient improved clinically on PPI and was discharged. She follows up in the internal medicine clinic regularly with no further complaints of debilitating nausea and vomiting. Discussion: Although gastric xanthomas are benign lesions, their etiology and clinical significance remain unclear. There are published reports suggesting possible association of xanthomas to precancerous lesions of gastric mucosa and thus possible need for endoscopic surveillance. Some gastric lesions show endoscopic or histopathologic features similar to those of xanthomas. Included are Russell body gastritis, xanthogranuloma, pseudoxanthoma elasticum and signet cell adenocarcinoma. Clinical significance of these lesions is different from gastric xanthoma and therefore correct histopathological diagnosis is important. Although there are no standard treatment recommendations for gastric xanthoma, some studies have proposed the use of proton-pump inhibitors.Figure 1.: 1a.- Histopathology showing lipid laden histiocytes 1b.- Endoscopic image of gastric nodule.