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Pathology of Gastric Xanthoma/ Xanthelasma (lipid islands)

Dr Sampurna Roy MD    


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Clinical significance of gastric xanthoma:  This lesion may be confused with a malignant tumour.

Associated with pathological lesions such as chronic gastritis & intestinal metaplasia, atrophic gastritis, and gastric ulcer .

Lipid islands are more common in certain conditions, such as diabetes mellitus, cholesterolosis of the gallbladder, obesity, and arteriosclerosis.  

Age and sex : More frequent in women and its incidence increases with age.

Site: Usually located at the antral and the lesser curvature, but occasionally present in the body or fundus. These lesions are rare in other parts of the gastrointestinal tract. Cases have been reported  in the small intestine, esophagus, and large intestine.

Gross: Single or multiple, round to oval shaped well circumscribed, pale yellow nodule or plaque (1 - 2 mm in diameter).

Microscopic features : Collection of mature lipid laden macrophages within the lamina propria.

Visit related posts:  Verruciform Xanthoma ; Xanthelasma ; Whipple disease

Differential diagnosis:  

Signet ring carcinoma : Isolated tumour cells may be present in the lamina propria . The tumour is positive for mucicarmine and cytokeratin. Gastric xanthoma: Positive with Sudan black, oil red O (on frozen section), and CD68, and are negative for PAS/alcian blue, mucicarmine and cytokeratin.

Clear cell carcinoid tumour of stomach : Chromogranin A positive.

Packaged appearance of the cells and vascular stroma in xanthoma may mimick neuroendocrine tumour.

Whipple disease and Mycobacterium auium-intracellulare are rare infections of the stomach. Special stains (periodic acid Schiff with diastase and acid-fast bacilli) helps in establishing the diagnosis.


Further reading:

Gastric xanthelasma may be a warning sign for the presence of early gastric cancer.

Gastric xanthelasma: an unusual endoscopic finding.

Xanthomatous hyperplastic polyps of the stomach: clinicopathologic study of 5 patients with polypoid gastric lesions showing combined features of gastric xanthelasma and hyperplastic polyp.

Gastric xanthelasma.

[A case of gastric xanthogranuloma associated with early gastric cancer].

Gastric xanthoma: a diagnostic problem on brushing cytology smears.

Gastric xantoma: histological findings and clinico endoscopic characteristics in the "Hospital Nacional 2 de Mayo"

Xanthelasmas of the upper gastrointestinal tract.

A close relationship between Helicobacter pylori infection and gastric xanthoma.

Clear cell carcinoid tumor of stomach. A variant mimicking gastric xanthelasma.

Helicobacter pylori infection in gastric xanthomas: immuno histochemical analysis of 145 lesions.

Gastric xanthelasma associated diffuse signet ring carcinoma. A potential diagnostic problem.


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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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