Daniela Gallo,E.  Dozio,E.  Trotti,E.  Piantanida,F.  Frattini,F.  Franzi,F.  Sessa,G. L.  Dionigi,Jessica Sabatino,L.  Bartalena,Maria Laura Tanda,Silvia Ippolito,
Gastric Xanthomatous Hyperplastic Polyps – Just an Incidental Endoscopic Finding?
Surgical Case Reports
2020
2613-5965
http://dx.doi.org/10.31487/j.SCR.2020.05.14
https://www.sciencerepository.org/gastric-xanthomatous-hyperplastic-polyps-just-an-incidental-endoscopic-finding_SCR-2020-5-114 
Abstract: Background: Laparoscopic sleeve gastrectomy (LSG) progressively became the preferred procedure
worldwide for the treatment of morbid obesity. Occasionally, unknown gastrointestinal diseases may be
incidentally discovered during the procedure or on the histologic gastric specimen. Gastric xanthomas are
uncommon lesions of the lamina propria, composed by foamy macrophages and mixed inflammatory
infiltrate. Rarely, xanthoma cells develop within a gastric hyperplastic polyp. Although usually benign, they
may be associated with pre-malignant conditions or even gastric cancer, making advisable an appropriate
workup.
Case Presentation: A hyperplastic polyp with xanthomatous proliferation was discovered in the gastric
specimen of a young man, suffering from severe obesity and metabolic syndrome. The patient had been
treated with proton pump inhibitors for gastric discomfort for years. After the surgical procedure, the gastric
discomfort rapidly disappeared.
Conclusion: Obesity is often complicated by gastrointestinal abnormalities discovered during ultrasound
or endoscopic procedures. Incidental findings of unknown gastric lesions are common occurrences during
sleeve gastrectomy. Although xanthelasmas per se are harmless, they might coexist with pre-malignant/
malignant lesions, especially when associated with gastric polyps. Thus, prompt intra-operative recognition
and adequate work-up are mandatory. Although cases of gastric polyps or xanthomas are not a novelty, to
our knowledge, this is the first case reporting about the discovery of a gastric hyperplastic polyp with
xanthomatous proliferation on gastric histological piece. From the discussion of this case and of similar
reports in the literature, we advocated for the importance of endoscopic screening in obese patients admitted
for bariatric surgery to address the proper surgical approach and follow-up.
Keywords: Xanthelasma, hyperplastic polyp with xanthomatous, cells, sleeve gastrectomy, severe obesity