Joshua Klein, DO1, Bradley Gaddis, DO1, Fred Wolodiger, MD2, Maurizio Miglietta, DO1. 1Hackensack University Medical Center at Palisades, 2Englewood Hospital and Medical Center
Introduction: Gastrointestinal lipomas are a rare entity that can arise in portions of the gastrointestinal tract. The most common location is the colon, followed by the small intestine, stomach, and esophagus respectively. Gastric lipomas comprise only 5% of lipomas found in the gastrointestinal tract and less than 3% of benign gastric neoplasms. These submucosal tumors, which are comprised of mature adipose tissue, are typically asymptomatic and usually found incidentally on abdominal imaging or upper endoscopy. In symptomatic patients, surgical resection remains the treatment, however with the advent of new techniques there have been numerous reports of endoscopic resection. This case report looks at a patient with a symptomatic gastric lipoma and discusses the literature regarding the treatment of these rare neoplasms.
Case Report: 68 y/o M presented with two-day history of melenic stools and lethargy. Hemoglobin on admission was 8.2. The patient underwent an EGD which revealed a submucosal gastric mass with a central mucosal ulceration. There was no stigmata of recent bleeding. A CT scan revealed a 6.5cm submucosal gastric mass consistent with a gastric lipoma. Due to the large size of this gastric lipoma, it was not amenable to endoscopic submucosal resection. Through an upper midline laparotomy, the stomach was mobilized allowing for exposure of the mass located on the posterior aspect of the greater curvature. The serosa overlying the mass was incised with electrocautery and the mass was dissected from surrounding tissue. The mucosa was noted to be adherent to the lipoma therefore the lipoma and mucosa were lifted from surrounding tissue and transected with a TA-90 stapler. Final pathology revealed a 7.5cm submucosal lipoma with overlying mucosal ulcerations. Immunostains for C-kit and DOG1 were negative.
Discussion: There is no general consensus in surgical literature regarding the best management of symptomatic gastric lipomas. Due to the rare nature of these submucosal tumors, much of the literature available is in the form of either small retrospective studies or case reports. With the advent of new endoscopic techniques and instruments there have been numerous reports of endoscopic resection utilizing techniques such as snare ligation, partial resection, and endoscopic submucosal dissection (ESD). ESD has shown to be effective in removal of submucosal gastric tumors less than 5cm, with resection rates approaching 92%. With tumors larger than 5cm, there is a higher incidence of incomplete resection, hemorrhage, and gastric perforation; therefore, formal surgical resection remains the treatment of choice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79624
Program Number: P134
Presentation Session: Poster (Non CME)
Presentation Type: Poster