Purpose: A 61-year-old Hispanic female presented with severe heartburn and bloating. She had been taking Nexium 40 mg daily with minimal relief. She denied abdominal pain, dysphagia, vomiting or weight loss. Upper endoscopy revealed a 10 cm smooth, yellowish, extra-mucosal semi-pedunculated mass in the body of the stomach. The esophagus and duodenum were normal. Endoscopic ultrasound revealed a uniformly hyperechoic submucosal mass in the stomach, consistent with a lipoma. Mucosal biopsies and FNA were negative for malignancy. In view of the patient's persistent symptoms, she underwent a hand assisted laparoscopic wedge resection of the stomach. A smooth, soft, yellowish mass in the body of the stomach near the greater curvature was removed. Pathology confirmed the mass to be a lipoma. Discussion: Gastric lipomas are an extremely rare cause of dyspepsia. Lipomas are the most common benign mesenchymal tumor. Lipomas may develop in all organs throughout the body. In the gut, lipomas present as submucosal fatty tumors. The most common locations include the esophagus, stomach, and small intestine. Symptoms may occur from luminal obstruction or bleeding. Microscopically, gastric lipomas consist of well-differentiated adipose tissue surrounded by a fibrous capsule. Giant gastric lipomas are not clearly defined in the literature, and the largest reported was up to 12 cm. We recommend use of the term GIANT for lipomas greater than 10 cm. Gastric lipomas >2 cm in size can be symptomatic. Hemorrhage, abdominal pain, obstruction, and dyspepsia represent the most common symptoms associated with gastric lipomas, although the vast majority are asymptomatic and discovered incidentally. Surgical resection remains the treatment of choice for symptomatic lipomas. Endoscopically, gastric lipomas typically appear as smooth submucosal masses with a yellowish hue. Since the lipoma is submucosal, standard mucosal biopsies typically are inadequate to establish a histologic diagnosis. Clues such as “tenting”, “cushion or pillow sign” help identify the lesion. Our case is unusual not only due to the size of the lipoma, but demonstrated that a lipoma can mimic dyspepsia in its clinical setting.Figure