Rare Case of Gastric Xanthelasmas 1891

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S1073 - S1074
• Main Authors: Elfanagely, Yousef, Skole, Kevin
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Abdomen; Biopsy; Colonoscopy; Gastroenterology; Pain; Patients
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01891

Xanthelasmas are benign lesions rarely found in the upper GI tract. These lesions can occur as solitary or multiple nodules and are most commonly found in the stomach (incidence of 0.23%). Xanthelasmas are described as yellow-white plaques and their etiology is unknown. A 27-year-old Hispanic man with no significant past medical history and a surgical history pertinent for laparoscopic appendectomy underwent an EGD and a colonoscopy for heme positive stool. Three months prior to the visit, he presented to his PCP with periumbilical abdominal pain for 1 day. Work-up noted positive fecal immunochemical test (FIT) and liver enzyme abnormalities. ALT and AST were 56 and 44 respectively, three months prior to the visit. Lipid profile was normal. At the visit, he no longer complained of abdominal pain. Bowel movements were normal and nonbloody. BMI was 30. Vitals and physical exam were unremarkable. EGD showed four whitish mucosal nodules (3-8 mm) in the posterior wall of the stomach and greater curvature of the gastric body. Biopsies were taken and consistent with gastric xanthelasmas. Colonoscopy showed a 4 mm semi-sessile polyp in the sigmoid colon that was resected. Gastric xanthelasmas are an uncommon finding. A literature review on PubMed and Web of Science identified 7 case reports from 1994 to 2018 on 9 patients found to have gastric xanthelasmas. Patients ranged in age from 2-77 years. Gastric xanthelasmas were found in the antrum, fundus, and posterior wall of the stomach. Biopsies revealed gastritis in 2 of the 9 patients and H. pylori infection in 1 of the 9 patients. The majority of patients had unremarkable past medical histories and laboratory findings. The indications for EGDs were vague abdominal (often epigastric) pain. Our patient similarly had an unremarkable past medical history, presenting with recent abdominal pain. Biopsies were negative for H. pylori. Studies have suggested an association of gastric xanthelasmas with intestinal metaplasia, H. pylori infection and gastric cancer. Hyperlipidemia is one of the proposed possible etiologies of gastric xanthelasmas, but there is no evident association between the two. Interestingly, our patient despite his normal lipid panel had a CT of the abdomen 7 years prior to the visit for suspected appendicitis which suggested diffuse fatty infiltration of the liver. More case reports and studies can aid our understanding of the risk factors for and the clinical significance of gastric xanthelasmas.