Gastric xanthalesmas: Report of five cases and review of the literature

Abstract

Xanthalesmas are incidental lesions that are rarely encountered during upper gastrointestinal (GI) endoscopy. The most frequent location of xanthelasma in the upper GI tract is the stomach. The reported incidence of gastric xanthelasma is quite variable: it rangs from 0.018% to 0.8%. Upper GI xanthelasmas have a typical endoscopic appearance of yellow-white well-demarcated single or multiple nodules or plaques, with a size varying from 1 to 10 mm in diameter. Xanthelasmas are composed of large foamy cells containing lipids. In this report; five patients who attended hospital with nonspesific symptoms and xanthelasma-like lesions were incidentally found on their endoscopic examination.

Keywords

• Endoscopy; histopathology; stomach; xanthelasma

References

1. Boger, A., Hort, W., 1977. The importance of smooth muscle cells in the development of foam cells in the gastric mucosa: An electron microscopic study. Virchows. Arch. A. Pathol. Anat. Histol. 372, 287-297.
2. Chen, Y.S., Lin, J.B., Dai, K.S., Deng, B.X., Xu, L.Z., Lin, C.D., Jiang, Z.G., 1989. Gastric xanthelasma. Chin. Med. J. 102, 639-643.
3. Covotta, A., Covotta, L., D’Ambra, G., Paoletti, M., Urbano, V., Midiri, G., Bertolotti, A., 1994. Gastric xanthomatosis in a patient with severe lipid metabolic disorder (Abstract). G. Chir. 15, 29-31.
4. De Roberto, G., Ravizza, D., Fiori, G., Trovato, C., Maffini, F., Tamayo, D., Crosta, C., 2009. A massive gastric xanthomatosis. Endoscopy. 41, 54-55. doi: 10.1055/s-2008-1077442.
5. Dreude, R.B., Balart, L.A., Herrington, J.P., Beckman, E.N., Burns, T.W., 1982. Gastric xanthoma: Histologic similarity to signet ring cell carcinoma. J. Clin. Gastroenterol. 4, 217-221.
6. Gencosmanoglu, R., Sen-Oran. E., Kurtkaya-Yapicier. O., Tozun N., 2004. Xanthelasmas of the upper gastrointestinal tract. J. Gastroenterol. 39, 215-219. doi: 10.1007/s00535-003-1288-3.
7. Gravina, A.G., Lacono, A., Alagia, I., D’Armiento, F.P., Sansone, S., Romano, M., 2009. Gastric xanthomatosis associated with gastric intestinal metaplasia in a dyspeptic patient. Digest. Liver Dis. 41, 765. doi: 10.1016/j.dld.2008.08.003.
8. Gürsoy, S., Yurci, A., Torun, E., Soyuer, I., Güven, K., Ozbakir, O., Yücesoy, M., 2005. An uncommon lesion: Gastric Xanthelasma. Turk J. Gastroenterol. 16, 167-170.

9. Hori, S., Tsutsumi, Y., 1996. Helicobacter pylori infection in gastric xanthomas: Immunohistochemical analysis of 145 lesions. Pathol. Int. 46, 589-593.
10. Isomoto, H., Mizuta, Y., Inoue, K., Matsuo, T., Hayakawa, T., Miyazaki, M., Onita, K., Takeshima, F., Murase, K., Shimokawa, I., Kohno, S., 1999. A close relationship between Helicobacter pylori infection and gastric xanthoma. Scand. J. Gastroenterol. 34, 346-352.
11. Kaiserling, E., Heinle, H., Itabe, H., Takano, T., Remele, W., 1996. Lipid islands in human gastric mucosa: Morphological and immunohistochemical findings. Gastroenterology. 110, 369-374. doi: http://dx.doi.org/10.1053/gast.1996.v110.pm8566582.
12. Khachaturian, T., Dinning, J.P., Earnest, D.L., 1998. Gastric xanthelasma in a patient after partial gastrectomy. Am. J. Gastroenterol. 93, 1588- 1589.
13. Luk, I.S., Bhuta, S., Lewin, K.J., 1997. Clear cell carcinoid tumor of stomach. A variant mimicking gastric xanthelasma. Arch. Pathol. Lab. Med. 121, 1100-1103.
14. Muraoka, A., Suehiro, I., Fujii, M., Ueno, H., Hayashi, S., Shimizu, K., Kitazawa, R., Kitazawa, S., Murakami, K., 1988. Type IIa early gastric cancer with proliferation of xanthoma cells. J. Gastroenterol. 33, 326-329.
15. Naito. M., Miura. S., Funaki. C., Tateishi. T., Kuzuya. F., 1991. Gastric xanthomas in the elderly. Nippon Ronen Igakkai Zasshi. 28, 683-687.
16. Oviedo, J., Swan, N., Farraye, F.A., 2001. Gastric xanthomas. Am. J. Gastroenterol. 96, 3216-3218. doi:10.1111/j.1572-0241.2001.05293.
17. Owen, D.A., 1999. The stomach. Diagnostic surgical pathology. Sternberg, S.S., eds. Lippincott Williams and Wilkins, Philadelphia, pp. 1311- 1347.
18. Petrov, S., Churtchev, J., Mitova, R., Boyanova, L., Tarsassov, M., 1999. Xanthoma of the stomach-some morphometrical peculiarities and scanning electron microscopy. Hepato-Gastroenterol. 46, 1220-1222.
19. Scheiman, J., Elta, G., Colturi, T., Nostrant, T., 1988. Colonic xanthomatosis. Relationship to disordered motility and review of the literature. Digest. Dis. Sci. 33, 1491-1494.
20. Sekikawa, A., Fukui, H., Maruo, T., Tsumura, T., Kanesaka, T., Okabe, Y., Osaki, Y., 2013. Gastric xanthalesma may be a warning sign fort he presence of early gastric cancer. J. Gastroenterol. Hepato. 24, 951-956. doi: 10.1111/jgh.12512.