Gastric Xanthoma is Associated with Malignant ad Premalignant Lesions

Abstract

Gastric xanthoma lesions, which involve lipid accumulation in the gastric mucosa, are found incidentally during upper endoscopy. These lesions have been reported in series of cases associated with metaplasia or
atrophy and in reports that link them to gastric cancer, but no analysis has been done to date that examines the possible connections among these associations. The aim of this study was to evaluate whether patients with xanthoma have more malignant lesions (dysplasia or cancer) or premalignant conditions (atrophy or metaplasia).
Materials and Methods: This is a retrospective case-control study that was conducted in the Hospital El Tunal among patients who underwent upper endoscopies for evaluation of dyspepsia. Participants were chosen
at random from among patients who had symptoms of dyspepsia. Each participant underwent endoscopy to check for xanthoma on the same day. All patients had biopsies taken and were assessed histologically for
H. pylori infection.
Results: The study enrolled a total of 186 patients who met the inclusion criteria of requiring upper endoscopy due to symptoms of dyspepsia. as was indicated field-work one EVDA that with uninvestigated dyspepsia
were recruited. Two groups of patients were compared: one included 90 patients who were diagnosed with xanthoma through gastric endoscopy (n = 90), and another group which consisted of 96 patients in whom no
symptoms of xanthoma were found. The average age of the patients with xanthoma was 57.4 years while the average age of the control group was 38.3 years. 35% of the xanthoma group were male while 35.6% of the
control group were male. 72% of the patients in the xanthoma group had only one lesion: 53% were located in the antrum, 32% were located in the corpus, 10% in the antrum or corpus, and 5% in the fundus. Among
patients without xanthomas, there were no cases of dysplasia (0%) while 5.5% of the patients with xanthomas (5 cases) developed dysplasia. Two were low grade and three were high grade. 66% of the xanthoma group
and 85% of the control group had H. pylori infections. Three patients in xanthoma group (3.3%) had early gastric cancer, but no patients in the control group had early gastric cancer.
Conclusion: Our study shows that gastric xanthomas are a risk factor for the premalignant conditions of atrophy and intestinal metaplasia. Most importantly, they are associated with dysplasia and gastric cancer which obliges us to be even more careful with endoscopic evaluations when we find xanthoma incidentally. Probably, these findings should be followed up with gastric mapping because of the high probability that we will find a premalignant condition. Nevertheless, larger multicenter studies to test these associations still need to be done.