A case of gastric lipoma resected by endoscopic submucosa dissection with difficulty in preoperative diagnosis

Analysis of Missed Diagnosis of Gastric Lipomas by CT

INTRODUCTION

Although Computed Tomography (CT) is the most convenient technology for the diagnosis of gastric lipoma, it also has a high rate of missed diagnosis of gastric lipoma.

OBJECTIVE

To analyze the causes of missed diagnosis of gastric lipomas by CT.

METHODS

We retrospectively studied the CT images and CT diagnosis reports of 25 cases of gastric lipoma confirmed by surgery or clinical follow-up at the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital from 2016 to 2020 and analyzed the causes of missed diagnosis of gastric lipomas.

RESULTS

Among the 25 cases of gastric lipomas included in this study, 17 cases (68.0%) were correctly diagnosed by CT, and 8 cases (32.0%) were missed, but there was no case of misdiagnosis. Eighteen cases (72.0%) of gastric lipomas were located in the gastric antrum, 2 cases (8.0%) at the junction of the gastric body and antrum, 5 cases (20.0%) at the fundus of the stomach, 23 cases (92.0%) under the gastric mucosa, and 2 cases (8.0%) under the gastric serous membrane. All gastric lipoma cases were manifested as round or oval-shaped low-density shadows with clear boundaries on CT. 22 cases (88.0%) showed homogeneous low-density shadows while 3 cases (12.0%) mainly showed low-density shadows containing medium-density strips. There was no obvious enhancement in the contrast-enhanced CT scan. The gastric lipoma cases missed by CT were all located under the gastric mucosa of the gastric antrum. When reading the CT images on the default upper abdominal window width and window level, all the missed lesions were similar to the gas image. And the straight meridian of the three lesions was less than 2 cm.

CONCLUSION

Fat density shadow in gastric antrum area was mistaken for gastrointestinal gas. Improper CT image window width and window levels and small gastric lipoma volume, along with insufficient knowledge of gastric lipomas imaging by the clinician, might be the main causes of missed diagnosis of gastric lipomas by CT. Familiarity with the CT manifestations of gastric lipomas and rich clinical experience can improve the rate of correct diagnosis of gastric lipomas by CT.

Gastrointestinal bleeding due to gastrointestinal lipoma: A case report

BACKGROUND

Lipomas are common harmless tumors that are created in the colon in the gastrointestinal tract. The aim of this study was to report a case study on gastrointestinal lipoma with GIB.

CASE PRESENTATION

A 38-year-old man was admitted to the hospital because of gastrointestinal bleeding for two months in December 2017. He had abdominal pain, dyspeptic disorders, vomiting, melena, and intermittent hematemesis without significant weight loss. Upper gastrointestinal endoscopy indicated a large subepithelial lesion in the antrum of the stomach with near-normal mucosa. Endoscopic ultrasound (EUS) showed a large well-defined heterogeneous mass-like lesion in the antrum of the stomach. A subtotal gastrectomy was done in the patient. The histology results of the separated samples presented a gastric lipoma.

CONCLUSION

Gastric lipoma is often yellowish. It might ulcerate and bleed, but it does so, only rarely. It most frequently occurs as a solitary and smooth mass in the gastric antrum.

Bleeding Gastric Lipoma Resected by Endoscopic Submucosal Dissection

Gastric lipomas are slow-growing benign lesions of the stomach that are often detected incidentally. Most cases are asymptomatic but larger lesions may become symptomatic, thereby requiring treatment. Multiple endoscopic modalities have been used for resection in the past. We present the case of a 67-year-old patient who presented with upper GI bleeding secondary to a gastric lipoma, which was successfully resected by endoscopic submucosal dissection.

Simultaneous resection of a gastric submucosal lipoma in the setting of bariatric surgery: A case report and review of current literature

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Important to rule out other tumors, such as GIST and malignancy.

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Pre-operative imaging including EUS is critical in choosing the appropriate surgery.

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Multiple modalities exist for excision of lipoma in setting of bariatric surgery.

Introduction

Gastric submucosal lipoma is an uncommon finding in the stomach. A benign fatty tumor that is asymptomatic majority of the time. However, symptomatic and bigger tumors can be difficult to manage surgically and require detailed surgical planning prior to proceeding with bariatric surgery.

Presentation of case

58 year old female who presented for weight loss consultation. Underwent an esophagogastroduodenoscopy (EGD) that demonstrated a 3 cm mass near the incisura. Endoscopic ultrasound (EUS) and biopsy demonstrated a submucosal lipoma. Due to the lipoma's location, resection was critical, as it would have led to obstructive symptoms following sleeve gastrectomy. The patient underwent a simultaneous laparoscopic vertical gastrectomy, gastric lipoma excision, EGD, and laparoscopic cholecystectomy

Discussion

Gastric lipomas are benign gastric submucosal tumors, representing less than 3% of all benign gastric neoplasms. Computer tomography and endoscopic ultrasound are important in establishing diagnosis. In current literature, excision with negative margins is standard of care, but small asymptomatic lesions can be followed without intervention.

Conclusion

Gastric lipoma are a rare type of gastric submucosal tumors. Size is highly variable. Observation is a reasonable approach when small and asymptomatic, but multiple surgical modalities can be utilized to remove the tumor. Careful utilization of pre-operative imaging including EUS is critical in choosing the appropriate surgery if simultaneous bariatric management is undertaken

Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review

OBJECTIVES

Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2 cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD.

METHODS

Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms.

RESULTS

We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7 cm × 3 cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2 cm or larger. The average size of the lipomas was 4 cm (range: 1.2-9 cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported.

CONCLUSION

Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.