Gastric Xanthomas Research Articles

Xanthomas and precancerous changes of the stomach: an accidental combination or an important prognostic endoscopic marker?

Background. The article deals with the study of gastric xanthomas, benign accidental formations with an unknown etiopathogenesis, which, according to the literature, are associated with a number of pathological conditions (atrophic gastritis, intestinal metaplasia, dysplasia, gastric cancer, dyslipidemia, etc.). The purpose was to study the prevalence of gastric xanthomas in patients with atrophic gastritis and to analyze their relationship with endoscopic changes in the stomach, including precancerous conditions. Materials and methods. Esophagogastroduodenoscopy was performed using the EVIS EXERA III video endoscopy system with the Olympus 190 gastroscope (Japan) in 120 patients with atrophic gastritis undergoing examination and treatment at the Institute of Gastroenterology of the National Academy of Sciences of Ukraine. The presence of duodenogastric reflux, the prevalence and severity of mucosal atrophy, changes in the relief of the gastric mucosa (including nodules and bumps), the presence of hyperplasia, polyps, hemorrhages, erosions, ulcers, xanthomas in the stomach were assessed. When using the narrow-band imaging and close focus, the presence and prevalence of intestinal metaplasia, the presence of gastric dysplasia were evaluated. Comparative and statistical analysis of endoscopic data was conducted depending on the presence of gastric xanthomas. Results. The heterogeneity of endoscopic changes in atrophic gastritis was revealed (prevalence and severity of atrophy, intestinal metaplasia, changes in the mucosal relief, presence of hyperplasia, polyps, ulcers, etc.). Gastric xanthomas were found in more than a third of patients with atrophic gastritis (36.7 % of cases), with predominant localization in the antral region (90.9 %). As a rule (95.5 %), they were single. In patients with atrophic gastritis associated with xanthomas, diffuse atrophic changes in gastric mucosa were detected significantly more often, as well as mucosal nodules and bumps, mucosal hyperplasia, intestinal metaplasia and the mucosal dysplasia, which was confirmed morphologically (p < 0.05). Rare cases of gastric ulcers and gastric cancer were diagnosed only in patients with xanthomas (p > 0.05). Conclusions. The obtained results indicate that gastric xanthoma is an important diagnostic marker of precancerous changes in the gastric mucosa: widespread atrophy, intestinal metaplasia, dysplasia, and can be used as an important prognostic marker for the development of gastric cancer. Patients with xanthoma-associated atrophic gastritis require a thorough examination using modern endoscopic equipment and dynamic observation, with a focus on changes in the gastric relief by the type of nodules and bumps.

S3088 A Rare Case of Xanthoma Presenting as Gastric Nodule

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.

S3520 An Unusual Surprise on Routine Colonoscopy

Introduction: Gastrointestinal xanthomas are rare, benign lesions that are incidentally found during endoscopy or colonoscopy. They most frequently occur in the stomach with incidence of gastric xanthomas reported to range between 1-4%. The incidence of colonic xanthoma is unknown but expected to be even lower as it is limited to a few case reports. Here, we present a rare occurrence of a xanthoma incidentally detected in the sigmoid colon. Case Description/Methods: A 77-year-old female presented for a screening colonoscopy. Her past medical history was significant for cirrhosis secondary to autoimmune hepatitis diagnosed 30 years ago and a prior colonoscopy notable for multiple tubular adenomas, tubulovillous adenoma and a transverse colon lipoma. Colonoscopy revealed multiple diverticula in the sigmoid and descending colon, a lipoma in the transverse colon and a polyp in the sigmoid colon. The polyp was 8 mm, semi-pedunculated and removed with a cold snare. Pathology identified the polyp as a xanthoma. Given history of tubulovillious polyp and multiple tubular adenomas, she was instructed to undergo a repeat colonoscopy in 5 years. Discussion: Colonic xanthomas are a rare occurrence with previous cases describing the most common location in the sigmoid colon. The largest case series of 28 colorectal xanthomas described the median age of the patients as 64 years and there were 15 men and 10 women. Macroscopically they generally present as plaques and rarely as polypoid lesions as seen in our patient. Microscopically they contain foamy macrophages that are thought to be lipids derived from damaged cell membranes. Unlike cutaneous xanthomas, gastrointestinal xanthomas do not have a clear association with hyperlipidemia. Our patient did not have history significant for diabetes or hyperlipidemia. Reported associations of colonic xanthomas include adenomas (16%) and adenocarcinomas (4.8%) and hence, should prompt a thorough examination when xanthomas are suspected during a colonoscopy. Although generally asymptomatic, they have a potential of presenting with gastrointestinal obstruction and therefore should be in the differential diagnosis for polypoid lesions found on colonoscopy.Figure 1.: Colonoscopy showing approximately 8mm polypoid lesion in the sigmoid colon.

Gastric Xanthomatous Hyperplastic Polyps – Just an Incidental Endoscopic Finding?

Background: Laparoscopic sleeve gastrectomy (LSG) progressively became the preferred procedure worldwide for the treatment of morbid obesity. Occasionally, unknown gastrointestinal diseases may be incidentally discovered during the procedure or on the histologic gastric specimen. Gastric xanthomas are uncommon lesions of the lamina propria, composed by foamy macrophages and mixed inflammatory infiltrate. Rarely, xanthoma cells develop within a gastric hyperplastic polyp. Although usually benign, they may be associated with pre-malignant conditions or even gastric cancer, making advisable an appropriate workup. Case Presentation: A hyperplastic polyp with xanthomatous proliferation was discovered in the gastric specimen of a young man, suffering from severe obesity and metabolic syndrome. The patient had been treated with proton pump inhibitors for gastric discomfort for years. After the surgical procedure, the gastric discomfort rapidly disappeared. Conclusion: Obesity is often complicated by gastrointestinal abnormalities discovered during ultrasound or endoscopic procedures. Incidental findings of unknown gastric lesions are common occurrences during sleeve gastrectomy. Although xanthelasmas per se are harmless, they might coexist with pre-malignant/ malignant lesions, especially when associated with gastric polyps. Thus, prompt intra-operative recognition and adequate work-up are mandatory. Although cases of gastric polyps or xanthomas are not a novelty, to our knowledge, this is the first case reporting about the discovery of a gastric hyperplastic polyp with xanthomatous proliferation on gastric histological piece. From the discussion of this case and of similar reports in the literature, we advocated for the importance of endoscopic screening in obese patients admitted for bariatric surgery to address the proper surgical approach and follow-up.

Gastric Xanthoma Associated with Gastric Cancer Development: An Updated Review.

Gastric xanthelasma (GX) is a rare tumor-like lesion customarily found as an incidental finding due to its asymptomatic appearance. Grossly, it is a well-marked yellow-white plaque created in the lamina propria by microscopic clusters of foamy macrophages. Xanthelasma is rarely correlated with gastric hyperplastic polyps; gastric xanthomas are rare benign lesions that appear to be associated with inflammation of the gastric mucosa. Etiopathogenesis is also unclear, but it has been suggested to be involved in chronic gastritis, infection with Helicobacter pylori (H. pylori), diabetes mellitus, and hyperlipidemia. The gastric xanthoma prevalence ranges from 0.23% to 7%. Orth first described the condition in 1887. It has been found that xanthelasmas are associated with chronic gastritis, gastrointestinal anastomosis, intestinal metaplasia, and H. pylori infection. These lesions predispose patients to gastric cancer conditions. Xanthoma (GX) was reported to be a predictive marker for early gastric cancer. However, the effectiveness of these scores and xanthoma (GX) as predictive markers for early gastric cancer detected after H. pylori eradication remains unknown.

1467 Are Those Really Xanthomas?

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.

1879 Gastric Xanthoma: A Rare Endoscopic Finding

INTRODUCTION: Xanthoma is defined as a localized lipid deposit within organs that may manifest as papules, plaques or nodules, most commonly in the skin. The extra-cutaneous manifestation is rare and sparsely reported. Gastrointestinal tract xanthomas are rare benign lesions which have been reported in the esophagus, stomach, and duodenum, with the stomach being the most common site in the upper GI tract with a reported incidence between 0.2-0.8% 1,2. Commonly characterized by yellowish-white plaque in the antrum or the pylorus of the stomach, histologically reveals foamy macrophages in the lamina propria3. CASE DESCRIPTION/METHODS: We present a case of a 63-year-old female with past medical history most significant for ESRD on hemodialysis, CVA with right-sided residual paralysis, atrial fibrillation on warfarin who was brought in after being found in a comatose state, soaked in her own blood due to a hemodynamically significant painless GI bleed with H/H drop to 3.0/15.0 which required ICU admission. After stabilization, the patient underwent upper GI endoscopy, push enteroscopy and colonoscopy which revealed a non-bleeding gastric ulcer, non-bleeding internal and external hemorrhoids, non-bleeding angioectasias in the duodenum and a 10mm raised mucosal nodule in the gastric antrum which was biopsied which revealed dense infiltrate of foamy macrophages with positive with CD 163 immunostain that expanded the lamina propria consistent with a xanthoma. Additionally, random stomach biopsy revealed chronic gastritis with intestinal metaplasia. DISCUSSION: This case allows us to understand the similarity in the appearance of gastric xanthomas and malignancy like signet cell carcinoma as well as study its reported association with dyslipidemias, gastric dysplasias and carcinogenesis, chronic and atrophic gastritis as well as gastritis caused by Helicobacter pylori making it imperative to confirm by histopathology and maintain a close follow up for monitoring its behavior.

Gastric Xanthomas and Fundic Gland Polyps as Endoscopic Risk Indicators of Gastric Cancer.

Background/AimsFundic gland polyps (FGPs), hyperplastic polyps (HPs), and xanthomas (XTs) are common benign gastric lesions that can be diagnosed by endoscopic appearance alone in most cases. The aim of this study was to evaluate associations between gastric cancer and these benign lesions.MethodsTwo expert endoscopists reviewed a series of gastroscopy images. FGPs, HPs, and XTs were diagnosed by endoscopic appearance, whereas all gastric cancers were confirmed pathologically.ResultsOf the 1,227 patients reviewed, 114 (9.3%) had a concurrent or past history of gastric cancer. The overall prevalences of FGPs, HPs and XTs were 9.4%, 6.3% and 14.2%, respectively. HPs and XTs coexisted in 1.6% of patients, whereas other combinations were rarer. XTs were observed in 39.3% and 11.5% of patients with and without gastric cancer, respectively (p<0.001). In contrast, no gastric cancer patients had FGPs, whereas 10.4% of patients without cancer had FGPs (p<0.001). The prevalence of HPs was similar between the two groups (8.8% and 6.0% of patients with and without cancer, respectively, p=0.29). Multivariate and Mantel-Haenszel analyses demonstrated that XTs were positively associated and FGPs were negatively associated with gastric cancer.ConclusionsXTs and FGPs might be useful as endoscopic risk indicators for monitoring gastric cancer.

Granüler hücreli tümör tanısında Nestin immunhistokimyasının kullanımı

Aim: Granular cell tumors (GCTs) show neuroectodermal differentiation. Morphologically, a wide variety of mesencymal tumors may have granular cell appearance. Nestin, which is an intermediate filament protein expressed in undifferentiated cells during central nerves system development and its tumors. We aim to determine the diagnostic utility of Nestin in diagnosis of GCTs. Methods: Nestin immunohistochemistry applied to GCT cases and other mesenchymal tumors which may have granular cytoplasm and the major differential diagnostic consideration of GCT. A total of 21 GCT from different tissues (including 7 in the esophagus, 8 originating from skin tissues, 4 in the tongue, 2 in the vocal cord), 17 gastrointestinal stromal tumor in the gastrointestinal tract, 8 leiomyoma (5 in the esophagus and 3 originating from skin tissues), 4 schwannoma (1 in the esophagus and 3 originating from skin tissues), subcutaneous mesenchymal tumors ( including 7 neurofibroma, 5 fibroma, 15 dermatofibroma), 20 melanocytic nevi, 15 gastric xanthomas and 15 xanthalesma of the skin were included the study. Results: Nestin positivity was detected in all GCTs. Additionally, strong Nestin positivity was seen in all gastrointestinal stromal tumors, schwannoma and neurofibroma cases. However, Nestin was negative in all leiomyoma, fibroma, dermatofibroma, melanocytic nevi, gastric xanthoma and xanthalesma cases. Conclusion: The study showed that Nestin immunohistochemistry has limitation in distinction of GCT from tumors arising from neural cell lineage such as gastrointestinal stromal tumor, schwannoma and neurofibroma; however, Nestin as a neural marker provides an evidence to neural origin of GCT and could be useful in distinction GCT from other mesenchymal tumors with granular cytoplasm such as leiomyoma, dermatofibroma and melanocytic nevi.

Gastric Xanthoma (GX) as an Incidental Endoscopic Finding: A Report of 2 Cases

Gastric xanthomas (GXs) are yellow mucosal lesions characterized by the accumulation of lipid-laden histiocytes in the lamina propria. It is usually an incidental endoscopic finding of unclear clinical significance. It has a quite variable incidence that increases with age. GX was reported to be associated with chronic gastritis, hyperplastic polyps, gastric cancer and H.pylori infection. It has been hypothesized that GX could be related to gastric injury, which was supported by the higher prevalence of gastric atrophy among reported cases. Surprisingly, no correlation between GX and hyperlipidemia was found. Case 1: A 54 year-old Caucasian female with a history of primary pulmonary hypertension and ESRD post renal and bilateral lung transplant, admitted to the hospital with epigastric pain. Vital signs were normal, physical examination was significant for mild epigastric tenderness. Laboratory work and Imaging studies were inconclusive. EGD was remarkable for a single 5 mm sessile in the gastric fundus, complete resection was accomplished. (Figure 1) Pathology results revealed GX with focal active inflammation and erosion, No Helicobacter pylori organisms identified. There was no evidence of malignancy.FigureCase 2: This is an 82 year-old male with a significant history of DM II and renal cell carcinoma, who presented to our hospital with melena. On physical examination, he looked pale and tired. Vital signs were stable, his labs were remarkable only for normocytic anemia (HB: 7.9 g/dL, MCV: 92 fL). EGD was performed next day and it revealed a mass in the gastric body and a small gastric antral polyp (Figure 2), both biopsied. Subsequently, pathology results showed clear cell carcinoma consistent with metastatic renal cell carcinoma (the mass). Gastric antral polyp biopsy was suggestive of gastric xanthoma, confirmed by immunohistochemical staining for CD68. Eventually, laparoscopic partial gastrectomy was performed successfully. GX is a rare condition of unknown etiology, there is increasing evidence on the association between GX and gastric injury. GX should be considered as a warning sign, to look for other concomitant serious conditions, most importantly gastric cancer. In our reported cases, there was no evidence of H. pylori infection or primary gastric cancer, lipid profile was normal. However, the second patient endoscopy revealed a metastatic gastric mass. We think it is prudent to look for GX gastric partners and always send for histologic confirmation.Figure

Clinicopathological Assessment of Gastric Xanthoma as Potential Predictive Marker of Gastric Cancer

Background/Aims: Gastric xanthomas are frequently observed in the stomach as small yellowish plaques or nodules. A close relationship among Helicobacter pylori infection, atrophic gastritis, and xanthomas has been reported. We assessed the clinicopathological features of gastric cancer with or without xanthomas. Methods: A total of 91 patients who were diagnosed as having early gastric cancer were enrolled. We evaluated the gastritis status using scores for gastritis and atrophy, positivity of H. pylori infection, the prevalence rate of xanthomas, and the clinicopathological features of gastric cancer. Results: Gastric xanthomas were observed in 72.5% of early gastric cancer cases. Scores for gastritis and atrophy were significantly higher in the xanthoma-positive group than those in the xanthoma-negative group. A higher prevalence of differentiated-type adenocarcinoma was found in the xanthoma-positive group. Among the cases with multiple gastric xanthomas, the prevalence of males was significantly higher than that of females. Conclusion: A high prevalence rate of gastric xanthomas in gastric cancer cases was shown. Xanthomas were highly associated with age, the severities of gastritis and atrophy, and differentiated-type adenocarcinoma. Regardless of the eradication of H. pylori, xanthomas may be useful predictive markers for the development of differentiated-type adenocarcinoma.

Los xantomas gástricos están asociados con lesiones malignas y premalignas

Los xantomas gástricos son lesiones encontradas incidentalmente en la endoscopia digestiva alta. Consisten en la acumulación de lípidos en la mucosa gástrica. Estas lesiones se han reportado en serie de casos asociadas con metaplasia o atrofia y en reportes de casos vinculados con cáncer gástrico; sin embargo, no se han realizado estudios comparativos que busquen comprobar esta asociación. El objetivo de este trabajo es evaluar si los pacientes con xantomas tienen más lesiones malignas (displasia o cáncer) o condiciones premalignas (atrofia o metaplasia). Materiales y métodos: se trata de un estudio retrospectivo de casos y controles realizado en el Hospital El Tunal, en pacientes que fueron sometidos a endoscopia de vías digestivas altas (EVDA) para evaluación de dispepsia. A cada caso de xantoma se le asignó un control de endoscopia realizado el mismo día por el síntoma de dispepsia y escogido de manera aleatoria. Todos los pacientes fueron sometidos a biopsias para evaluación histológica y por infección de Helicobacter pylori. Resultados: en total se reclutaron 186 pacientes que cumplieron los criterios de inclusión, ya que tenían indicación de EVDA porque cursaban con dispepsia no investigada. Fueron comparados dos grupos de pa- cientes: el primero, con hallazgo de xantomas gástricos en la endoscopia (n = 90) y el segundo, sin estos hallazgos (n = 96). El promedio de edad de los pacientes con xantomas fue de 57, 4 versus 38,3 del grupo control, 35% sexo masculino versus 35,6%, respectivamente. Los xantomas fueron únicos en el 72%. La mayoría se ubicó en el antro (53%), cuerpo (32%), antro o cuerpo (10%) y fondo (5%). En los pacientes sin xantomas no se presentaron casos de displasia (0%), mientras que en el grupo con xantomas, 5,5% de los pacientes lo presentó (5 casos), de los cuales 2 fueron de bajo grado y 3, de alto grado. El 66% del grupo xantoma versus el 85% del control tenía infección por H. pylori. Tres pacientes presentaron cáncer gástrico temprano (3,3%) en el grupo de los xantomas versus 0% en el control. Conclusión: nuestro trabajo muestra que los xantomas gástricos son un factor de riesgo para la presencia de condiciones premalignas: atrofia o metaplasia intestinal. Lo más importante es que están asociados con displasia y cáncer gástrico, lo cual nos obliga a ser aún más cuidadosos en la evaluación endoscópica, cuan- do nos encontremos incidentalmente un xantoma, y probablemente a realizarles un mapeo gástrico, ya que por lo general es posible observar una condición premaligna. Sin embargo, se deben llevar a cabo estudios más grandes y multicéntricos para comprobar estas asociaciones.

Gastric Xanthoma: A Review of the Literature

Context: Xanthelasmas, also known as “xanthomas” and “lipid islands” are yellow plaque-like lesions characterized by the presence of lipid-containing histiocytes. Evidence Acquisition: Xanthomas are most commonly found in the stomach within the gastrointestinal tract, and at this location they are called Gastric Xanthoma (GX). Clinical significance of GX is still unknown. It has been suggested that GX could be related to gastric injury. Here we reviewed five decades of studies on GX in the literature. Results: Since, GXs was reported to be associated with potentially serious conditions of the stomach, the whole gastric mucosa should be examined carefully and biopsy should be taken from the lesion during the upper gastrointestinal endoscopy for diagnosis and rulling out gastric malignity. Conclusions: Gastric xanthomas should not be ignored and concomitant conditions should be treated.

A Rare Case of Pediatric Gastric Xanthoma: Diagnosis and Follow-up

Introduction and Aim: Gastric xanthomas are rare benign lesions that appear to be associated with inflammation of the gastric mucosa. Their etiology has yet to be fully elucidated and only one pediatric case and a few adult cases have been described to date. We report on a pediatric case of gastric xanthomatosis. Case report: A 13-yearold girl with dysphagia, burning sensation in the chest, regurgitation and rumination after meals (with no abdominal pain or altered stool frequency) underwent upper GI endoscopy, disclosing six gastric lesions appearing as nodules and soft pseudo-polyps measuring 0.5-1 cm, with a “papilloma-like” greyish-white top. Histology identified foamy histiocytes leading to the diagnosis of gastric xanthoma. No treatments have been administered to the patient during a 1-year follow-up, and the girl’s signs and symptoms have resolved spontaneously. Discussion and Conclusions: It is important to recognize gastric xanthomas because they often have an ulcerlike appearance at endoscopy, and inappropriate antacid treatment might consequently be prescribed. Taking biopsies during upper GI endoscopy is fundamental to the diagnosis of gastric xanthoma, as well as to exclude gastric tumors.

A massive gastric xanthomatosis

are incidental lesions rarely encountered during upper gastrointestinal endoscopy. We report a case of gastric xanthomatosis in a 49-year-old asymptomatic woman affected by pulmonary B-cell lymphoma. She underwent esophagogastroduodenoscopy to stage her lymphoproliferative disease. The previous medical history was unremarkable, blood chemistry was normal, and she was not receiving any medication. The upper endoscopy showed soft, white/yellowish, isolated, and confluent multiple nodules, 3 –8 mm in diameter, mainly distributed in the gastric corpus, primarily along the greater curvature (l Fig. 1). The histopathologic diagnosis was established by the observation of foamy histiocytes in the mucosal layer with hematoxylin and eosin (H&E) staining (l Fig. 2). The absence of nuclear atypia and cytokeratins (l Fig. 3) excluded any gastric malignancies. No follow-up was suggested. Xanthelasma is usually observed in elderly women and the most frequent gastrointestinal site is the stomach. Gastric xanthomas frequently occur in a mucosa where pathological changes such as chronic gastritis, intestinal metaplasia, atrophic gastritis, or gastric ulcer are observed [1]. Although the pathogenesis of xanthelasma is still unclear, it has been suggested that its development might be a response to mucosal damage by a mechanism in which lipids derived from broken-down cell membranes are captured by intestinal histiocytes [2]. The typical endoscopic appearance of xanthelasma is of yellow-white, well-demarcated, single or multiple nodules or plaques, ranging in size from 1 to 10 mm in diameter [3]. On histopathologic evaluation, they are characterized by the presence of numerous foamy histiocytes in the lamina propria. This microscopic appearance is reminiscent of that observed in signet ring-cell carcinoma, which is histologically the main differential diagnosis associated with xanthelasma [4]. No treatment or follow-up is necessary but histologic assessment is mandatory because some gastric malignancies may also macroscopically resemble these benign lesions [5]. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH A massive gastric xanthomatosis

Ectopic Sebaceous Glands in the Esophagus: Report of Two Cases

Abstract: Reports of ectopic sebaceous glands in the esophagus are rare. Six postmortem cases and eight antemortem cases have been reported. In 1990, we studied two patients with ectopic sebaceous glands in the esophagus that were found during endoscopy and confirmed histologically. These lesions macro‐scopically resembled gastric xanthomas.

老年者胃黄色腫に関する研究 とくに血清脂質，胃粘膜組織像との関係について

Gastric xanthomas are single or multiple yellowish-white small nodules or plaques in the gastric mucosa. Microscopically they consist of macrophage-derived foam cells full of lipids. However, because of their benign nature, there are few reports of gastric xanthomas in the literature and their clinical significance still remains unknown. In this study, we studied 131 elderly cases (42 males and 89 females) with the average age of 75.6 +/- 12.3 (S.D.) years old who were examined gastroendoscopically. The endoscopic finding of gastric xanthomas was observed in 17 males (40.5%) and in 23 females (25.8%). Gastric xanthomas tended to increase with age, and the frequency was highest in the seventies (40.0%). Of the xanthoma cases, 42.5% had a solitary xanthoma, and 17.5% had more than 5 xanthomas. More than 70% of xanthomas were observed in antral and pyloric regions. There was no difference in serum lipids between the cases with and without xanthomas. Gastric mucosa biopsied from around xanthomas showed moderate to severe atrophic change of gastric glands in most cases (89%). Hyperplasia of gastric-pit epithelia and intestinal metaplasia were also often observed. However, there was no correlation between gastric xanthomas and small round cell infiltration in the gastric mucosa. It was concluded that gastric xanthomas in the elderly arise from the mucosa with atrophic change in most cases, which may have a disturbance of local lipid metabolism, and that the presence of gastric xanthomas may be a marker of the pathological aging change of gastric mucosa.

Gastric xanthomas

Gastric xanthomas (GX) are uncommon intramucosal lesions which can be misinterpreted as early or signet ring adenocarcinoma. The histological features of eight gastric xanthomas are described. Mucin and Masson trichrome strains were valuable in distinguishing GX from adenocarcinoma.

Gastric Xanthoma

Gastric xanthomas (GX) are pale yellow nodules or plaques, usually less than 3 mm in size, in the gastric mucosa. They are frequently found in groups, most often along the lesser curvature and pyloric regions. They consist of liquid-laden histiocytes in the lamina propria occasionally extending into the submucosa. There is no correlation between GX and hypercholesterolemia. The lesion is of little significance, except as it may be misdiagnosed as carcinoma. We present two cases of GX, one initially thought histologically to be a signet ring cell carcinoma. With the paucity of reports of GX in the medical literature and the potential for incorrect diagnosis, we emphasize the importance of recognition and accurate histologic diagnosis of GX.