1879 Gastric Xanthoma: A Rare Endoscopic Finding

INTRODUCTION: Xanthoma is defined as a localized lipid deposit within organs that may manifest as papules, plaques or nodules, most commonly in the skin. The extra-cutaneous manifestation is rare and sparsely reported. Gastrointestinal tract xanthomas are rare benign lesions which have been reported in the esophagus, stomach, and duodenum, with the stomach being the most common site in the upper GI tract with a reported incidence between 0.2-0.8% 1,2 . Commonly characterized by yellowish-white plaque in the antrum or the pylorus of the stomach, histologically reveals foamy macrophages in the lamina propria 3 . CASE DESCRIPTION/METHODS: We present a case of a 63-year-old female with past medical history most significant for ESRD on hemodialysis, CVA with right-sided residual paralysis, atrial fibrillation on warfarin who was brought in after being found in a comatose state, soaked in her own blood due to a hemodynamically significant painless GI bleed with H/H drop to 3.0/15.0 which required ICU admission. After stabilization, the patient underwent upper GI endoscopy, push enteroscopy and colonoscopy which revealed a non-bleeding gastric ulcer, non-bleeding internal and external hemorrhoids, non-bleeding angioectasias in the duodenum and a 10mm raised mucosal nodule in the gastric antrum which was biopsied which revealed dense infiltrate of foamy macrophages with positive with CD 163 immunostain that expanded the lamina propria consistent with a xanthoma. Additionally, random stomach biopsy revealed chronic gastritis with intestinal metaplasia. DISCUSSION: This case allows us to understand the similarity in the appearance of gastric xanthomas and malignancy like signet cell carcinoma as well as study its reported association with dyslipidemias, gastric dysplasias and carcinogenesis, chronic and atrophic gastritis as well as gastritis caused by Helicobacter pylori making it imperative to confirm by histopathology and maintain a close follow up for monitoring its behavior.