Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier’s disease with an underlying lipoma: A case report

Figure 1 Polypoid mass found in the stomach during esophagogastroduodenoscopy. A: A mass (4 cm × 1 cm) with enlarged mucosal folds in the body of the stomach between the lesser curvature and posterior wall; B: A small ulcer at the distal end of the mass.

Figure 2 Computed tomography of the abdomen with contrast enhancement. A: A submucosal lesion in the stomach. Mean density of -89 HU suggested a submucosal lipoma; B: Length, 4.86 cm; C: Width, 1.96 cm.

Figure 3 Resection of the mass via tunneling endoscopic submucosal dissection. A: A tunnel was created in the submucosal layer beneath the mass; B: Dissection was performed on both sides of the tunnel; C: Muscular defects were closed, and mucosal margins approximated with clips.

Figure 4 Resected specimen. A: Immediately after resection, enlarged gastric folds were observed on the surface; B: Intersected specimen in the Pathology Department. Yellow tissue of the submucosal lipoma was observed.

Figure 5 Histological changes in Ménétrier’s disease. A: Low magnification; B: Cystic dilation of deep glands with foveolar hyperplasia; C: Foveolar hyperplasia with tortuous glands; D: Foveolar hyperplasia with dilation of the glands and oxyntic atrophy.

Figure 6 Submucosal lipoma and accompanying changes in the course of Ménétrier’s disease. A: Low magnification; B: Foveolar hyperplasia; C: Foveolar hyperplasia with a corkscrew morphology; D: Foveolar hyperplasia with tortuous glands and mild inflammation in lamina propria.

Figure 7 Histological changes in the course of Ménétrier’s disease: Foveolar hyperplasia, proliferation of muscularis mucosae and mild inflammation of lamina propria.

Figure 8 The mucosa with changes in the course of Ménétrier’s disease and the adjacent submucosal lipoma. The lipoma was adjacent to the mucosa without crossing its borders. A: Low magnification; B, C and D: Representative images taken at high magnification.