# A Case of Two Diametrically Opposed Gastric Xanthomas in the Pyloric Antrum: An Unusual and Benign Endoscopic Finding

## TL;DR

A 74-year-old woman had yellowish stomach plaques diagnosed as benign gastric xanthomas, which can resemble cancer and need careful evaluation.

## Contribution

This case highlights the importance of accurate endoscopic and histological diagnosis of gastric xanthomas to avoid misdiagnosis.

## Key findings

- Gastric xanthomas were identified in the pyloric antrum via endoscopy and confirmed histologically.
- The case emphasizes the need for careful evaluation due to potential associations with premalignant or malignant changes.
- The patient had no abnormal physical or laboratory findings, but the endoscopic appearance raised suspicion of malignancy.

## Abstract

Gastrointestinal tract xanthomas are rarely encountered findings in upper gastrointestinal endoscopy. They are non-tumor, well-demarcated, yellowish mucosal plaques most commonly diagnosed in the stomach, especially in the antrum or the pyloric region. Histologically, a gastric xanthoma consists of foamy histiocytes in the lamina propria. Although it is a benign lesion, it can be associated with various precancerous conditions and its appearance can resemble malignancy.

We report the case of a 74-year-old female patient who presented to the outpatient clinic with a six-month history of intermittent pain in the epigastrium. The patient’s physical examination as well as the hematological and biochemical investigations were normal. The upper gastrointestinal endoscopy revealed yellowish plaques in the pyloric antrum of the stomach, which were diagnosed as gastric xanthomas by histological examination.

The significance of gastric xanthomas in relation to gastric disease still remains to be determined. Given the frequent association of gastric xanthomas and known premalignant lesions and occasionally malignant changes of the gastric mucosa, we need to pay close attention to endoscopic diagnosis and histochemical and immunohistochemical evaluation.