Published online Aug 14, 2017. doi: 10.3748/wjg.v23.i30.5619
Peer-review started: April 11, 2017
First decision: April 17, 2017
Revised: May 4, 2017
Accepted: June 18, 2017
Article in press: June 19, 2017
Published online: August 14, 2017
To systematically review the syndrome of giant gastric lipomas, report 2 new illustrative cases.
Literature systematically reviewed using PubMed for publications since 1980 with following medical subject heading/keywords: (“giant lipoma”) AND (“gastric”) OR [(“lipoma”) and (“gastric”) and (“bleeding”)]. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Computerized review of pathology/endoscopy records at William Beaumont Hospitals, Royal Oak and Troy, Michigan, January 2005-December 2015, revealed 2 giant gastric lipomas among 117110 consecutive esophagogastroduodenoscopies (EGDs), which were thoroughly reviewed, including re-review of original endoscopic photographs, radiologic images, and pathologic slides.
Giant gastric lipomas are extremely rare: 32 cases reported since 1980, and 2 diagnosed among 117110 consecutive EGDs. Average patient age = 54.5 ± 17.0 years old (males = 22, females = 10). Maximal lipoma dimension averaged 7.9 cm ± 4.1 cm. Ulcerated mass occurred in 21 patients. Lipoma locations: antrum-17, body-and-antrum-4, antrum-intussuscepting-into-small-intestine-3, body-2, fundus-1, and unspecified-5. Intramural locations included submucosal-22, subserosal-2, and unspecified-8. Presentations included: acute upper gastrointestinal (UGI) bleeding-19, abdominal pain-5, nausea/vomiting-5, and asymptomatic-3. Symptoms among patients with UGI bleeding included: weakness/fatigue-6, abdominal pain-4, nausea/vomiting-4, early-satiety-3, dizziness-2, and other-1. Their hemoglobin on admission averaged 7.5 g/dL ± 2.8 g/dL. Patients with GI bleeding had significantly more frequently ulcers than other patients. EGD was extremely helpful diagnostically (n = 31 patients), based on characteristic endoscopic findings, including yellowish hue, well-demarcated margins, smooth overlying mucosa, and endoscopic cushion, tenting, or naked-fat signs. However, endoscopic mucosal biopsies were mostly non-diagnostic (11 of 12 non-diagnostic). Twenty (95%) of 21 abdominal CTs demonstrated characteristic findings of lipomas, including: well-circumscribed, submucosal, and homogeneous mass with attenuation of fat. Endoscopic-ultrasound showed characteristic findings in 4 (80%) of 5 cases: hyperechoic, well-localized, mass in gastric-wall-layer-3. Transabdominal ultrasound and UGI series were generally less helpful. All 32 patients underwent successful therapy without major complications or mortality, including: laparotomy and full-thickness gastric wall resection of tumor using various surgical reconstructions-26; laparotomy-and-enucleation-2; laparoscopic-transgastric-resection-2; endoscopic-mucosal-resection-1, and other-1. Two new illustrative patients are reported who presented with severe UGI bleeding from giant, ulcerated, gastric lipomas.
This systematic review may help standardize the endoscopic and radiologic evaluation and therapy of patients with this syndrome.
Core tip: Systematic literature review of giant gastric lipomas revealed 32 reported cases since 1980, with 2 new cases reported among 117110 esophagogastroduodenoscopies. Two authors independently reviewed literature, and decided by consensus which articles to incorporate. Average-patient-age = 54.5 ± 17.0 years (males = 68.8%). Mean-maximal-lipoma-diameter = 7.9 cm ± 4.1 cm. Lipoma locations: antrum-17, antrum and other gastric segments-7, other-8. Lipomas were submucosal-92%, subserosal-8%. Presentations included: acute upper gastrointestinal (UGI) bleeding-19, abdominal pain-5, nausea/vomiting-5, asymptomatic-3. Esophagogastroduodenoscopy was extremely helpful diagnostically; findings included: yellowish hue, well-demarcated margins, and smooth overlying mucosa. Endoscopic biopsies were infrequently diagnostic. Twenty of 21 abdominal CTs demonstrated characteristic lipoma findings: well-circumscribed, submucosal, and homogeneous mass with fat attenuation. Endoscopic-ultrasound showed characteristic findings in 80%. All patients underwent successful therapy without major complications/mortality, including: laparotomy-with-full-thickness-gastric-wall-resections-26; and other-6. Two newly reported patients presented with severe UGI bleeding from giant, ulcerated, gastric lipomas. This review may help standardize work-up of these patients.