A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb: a case report

Abstract

Figures

Endoscopic findings. a Giant cerebriform submucosal lipoma in the gastric body. b Giant cerebriform submucosal lipoma in the gastric antrum.

Contrast-enhanced computed tomography showed fat-dense nodules.

Histological analysis revealed mature fat tissue in the lamina propria and submucosa, diagnostic of lipoma (hematoxylin and eosin ×100).

Full text

Lipomas are benign tumors composed of mature adipocytes. Gastrointestinal (GI) lipomas are rare neoplasms, particularly those occurring in the stomach, which account for only 5% of all GI lipomas and 2%–3% of all benign gastric tumors. They are most commonly found in the gastric antrum 1 2 . Gastric lipomas are typically small and asymptomatic; however, as they enlarge, symptoms such as epigastric discomfort, gastric outlet obstruction, and dyspepsia may occur 3 .

We report the case of a 47-year-old man who was referred to our department following the detection of a large submucosal protrusion during an upper GI endoscopy at an external hospital. Esophagogastroduodenoscopy revealed a giant subepithelial lesion ( Fig. 1 ). Extensive, thickened, fold-like and nodular mucosal elevations resembling cerebriform changes were observed from the greater curvature of the lower gastric body to the antrum. A prominent protrusion extended into the duodenal bulb through the pylorus, with smooth overlying mucosa and a soft texture. Endoscopic ultrasonography demonstrated that the lesion was primarily located in the submucosa, with localized thickening up to 1.6 cm, exhibiting homogeneous hyperechogenicity. Elastography indicated a soft consistency, consistent with the characteristics of a lipoma. Contrast-enhanced computed tomography revealed nodular and mass-like lesions with fat density in the gastric body, antrum, and adjacent duodenal region, with the largest measuring approximately 7.2 × 5.8 cm, suggestive of a lipoma ( Fig. 2 ).

Endoscopic findings. a Giant cerebriform submucosal lipoma in the gastric body. b Giant cerebriform submucosal lipoma in the gastric antrum.

Contrast-enhanced computed tomography showed fat-dense nodules.

Endoscopic snare electrocautery resection was performed to remove two large tissue specimens for pathological examination, with no postoperative bleeding observed at the resection site ( Video 1 ).

A giant cerebriform submucosal lipoma extending from the gastric body to the duodenal bulb.Video 1

Histopathological examination of the biopsy specimens confirmed the presence of mature adipose tissue in the lamina propria and submucosa, supporting the diagnosis of a lipoma ( Fig. 3 ).

Histological analysis revealed mature fat tissue in the lamina propria and submucosa, diagnostic of lipoma (hematoxylin and eosin ×100).

To our knowledge, this is the first reported case of a giant gastric lipoma exhibiting cerebriform morphology and extending from the gastric body to the duodenal bulb. Although the lesion was extensive, the intact mucosa and absence of malignant features supported a benign diagnosis. Conservative management with regular follow-up may be considered; however, endoscopic resection should be performed if symptoms such as obstruction, bleeding, or ulceration develop 4 .

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB