Introduction: Lipomas are slow-growing benign tumors which are rarely found in the gastrointestinal tract. They are more common in the colon, but can also be found in the stomach. Gastric lipomas represent < 3% of benign gastric tumors, and giant gastric lipomas ( >4cm) are even less common. Most lesions remain asymptomatic, but pain, dyspepsia, intussusception, obstruction and bleeding occur as their size increases. There are few reports of giant gastric lipomas in the literature. We present an illustrative case.
Case Description/Methods: A 52-year-old Asian male presented to our outpatient clinic with pain and burning in the stomach for about six to eight weeks. He denied nausea, vomiting, early satiety, or weight loss. His symptoms were somewhat improved after eating and with OTC omeprazole. He reported consuming 3-4 drinks of alcohol every few days as well as smoking 1/2 pack per day for the last two years. On physical exam vitals were normal and he had mild epigastric tenderness. The only abnormal lab was a mildly elevated ALT of 47. Upper endoscopy revealed a large ulcerated mass with normal overlying mucosa in the gastric cardia. This was biopsied and pathology was reported as chronic active inflammation, ulceration, and granulation tissue. Staining for Helicobacter pylori returned negative. EUS confirmed an intramural, subepithelial lipoma at the lesser gastric curvature. FNA was negative for malignant cells; only lymphocytes and neutrophils were seen. The patient underwent robotic wedge gastrectomy and complete resection of the giant 8cm gastric lipoma with complete resolution of symptoms four weeks post-operatively.
Discussion: Giant gastric lipomas are sparsely reported in the literature. One review suggested that these lesions frequently present with life-threatening UGI bleeding. Diagnostic workup generally includes EGD and abdominopelvic CT. FNA via EUS is pursued when initial biopsies are inconclusive. There is no universally accepted standardization of therapy once lipoma is confirmed. Endoscopic or surgical resection result in a highly favorable prognosis. Our patient was found to have an 8cm lipoma that caused only vague symptoms of dyspepsia and epigastric pain, and proceeded for a totally robotic approach for resection with complete resolution of his presenting complaints. His case illustrates the heterogeneity in possible presentations of this infrequently described scenario. His favorable outcome highlights the success of minimally invasive surgery as a therapeutic modality.
