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, 5 (2), 20180109
eCollection

Gastric Lipomas: A Case Series and Review of a Rare Tumor

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Gastric Lipomas: A Case Series and Review of a Rare Tumor

Ian W Sullivan et al. BJR Case Rep.

Abstract

The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.

Figures

Figure 1.
Figure 1.
CT and MRI images of a single gastric lipoma. (a) Axial non-contrast CT of the abdomen demonstrates an oval hypoattenuating lesion with HU of −90 within the gastric pylorus, diagnostic for gastric lipoma. (b) Axial MRI T2 W imaging demonstrates signal within the lipoma isointense with the surrounding peritoneal fat. (c) Axial MRI gradient echo out of phase imaging demonstrates chemical shift artifact around the lipoma, diagnostic for its fat content. HU, Hounsfield units; T2 W, T 2 weighted.
Figure 2.
Figure 2.
Endoscopic images, histology, CT, and PET-CT fusion images of a single gastric lipoma. (a) Endoscopic image of normal gastric mucosa overlying a convex submucosal mass within the antrum. (b) Mucosal biopsy of the mass demonstrates normal gastric mucosa on histology. No adipose tissue was obtained. (c) 3 years later on axial imaging from a low-dose CT the mass is visualized as a hypoattenuating lesion with HU of −50 consistent with lipoma and thin soft tissue septations, likely representing post-biopsy changes. (d) Fludeoxyglucose-PET fusion with the low-dose CT in Figure 2c demonstrates non-significant uptake of 1.7 SUV within the lipoma. HU, Hounsfield units; PET, positron emission tomography.
Figure 3.
Figure 3.
Diagnosis of gastric lipoma by low-dose protocol CT (Figure 2 for low-dose imaging from a PET-CT) (a) Axial imaging from a coronary calcium scoring protocoled CT partially visualizes an oval lesion within the gastric body with HU of −120, diagnostic of gastric lipoma. (b) Axial imaging from a renal stone protocoled CT demonstrates an oval lesion within the gastric body with HU of −100, diagnostic of gastric lipoma. HU, Hounsfield units; PET, positron emission tomography.

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