Excessive fat accumulation in the gastrointestinal tract is pathologic. Gastric mucosal polyposis due to excessive submucosal fat infiltration in a bariatric partial gastrectomy specimen was encountered, which has not been described in the literature. This observation prompted us to assess the extent of fat in gastric submucosa and study the incidence of mucosal polyposis due to submucosal fat accumulation in morbidly obese patients.
Materials and Methods
Archived pathology slides of 128 bariatric partial gastrectomy specimens including the index case and 89 control cases obtained from Whipple’s procedure were examined. The amount of submucosal fat was categorized as 0 (no fat), 1 (up to 70% fat), and 2 (> 70% fat). The maximum submucosal fat thickness was measured with the interval cutoff of 5 mm and 10 mm.
Of the 128 cases, 90 (70.3%) were category 1 and 31 (24.2%) were category 2. Maximum submucosal fat thickness was > 10 mm in 3 (2.3%) cases including the index case. The extent of submucosal fat accumulation correlated with the body mass index. The frequencies of category 2 and > 10 mm of fat thickness were higher in the bariatric patient group compared with the control group.
We propose a submucosal fat thickness of > 10 mm and diffuse (> 70%) fat accumulation as diagnostic criteria for gastric lipohyperplasia. Using these criteria, the prevalence of gastric lipohyperplasia in the morbidly obese population is 2.3%. A subset of these may present as gastric mucosal polyps.
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Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017;5(7):161.
Gustafson B, Smith U. Regulation of white adipogenesis and its relation to ectopic fat accumulation and cardiovascular risk. Atherosclerosis. 2015;241(1):27–35.
Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med. 2014;371(12):1131–41.
Jones B, Fishman EK, Hamilton SR, et al. Submucosal accumulation of fat in inflammatory bowel disease: CT/pathologic correlation. J Comput Assist Tomogr. 1986;10(5):759–63.
Harisinghani MG, Wittenberg J, Lee W, et al. Bowel wall fat halo sign in patients without intestinal disease. Am J Roentgenol. 2003;181(3):781–4.
Eyselbergs M, Ceulemans LJ, De Bontridder S, et al. Ileocolic intussusception due to lipomatosis of the ileum: a common complication of a rare clinical entity. JBR-BTR. 2014;97(1):36–8.
Hamid HKS, Ahmed I, Mohamed A, et al. Ileocecal lipohyperplasia presenting as a chronic sideropenic anemia. BMC Case Rep. 2013;2013:bcr-2012-008052.
Tawfik OW, McGregor DH. Lipohyperplasia of the ileocecal valve. Am J Gastroenterol. 1992;87(1):82–7.
Djuric-Stefanovic A, Ebrahimi K, Sisevic J, et al. Gastroduodenal lipomatosis in familial multiple lipomatosis. Med Princ Pract. 2017;26(2):189–91.
Jeong IH, Maeng YH. Gastric lipomatosis. J Gastric Cancer. 2010;10(4):254–8.
Pickhardt PJ, Asher DB. Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison. Am J Roentgenol. 2003;181(4):973–9.
Devlies F, Hoe LV, Leemans A-M, et al. Gastroduodenal lipomatosis. Eur Radiol. 1997;7(3):338–40.
Jayasundara J, Sellahewa C, Hall A, et al. A case of gastroduodenal lipomatosis. Ann R Coll Surg Engl. 2016;98(8):e203–5.
Peabody JW, Ziskind J. Lipomatosis of the stomach; a case report and a review of the literature. Ann Surg. 1953;138(5):784–90.
Renehan AG, Zwahlen M, Egger M. Adiposity and cancer risk: new mechanistic insights from epidemiology. Nat Rev Cancer. 2015;15(8):484–98.
Yang P, Zhou Y, Chen B, et al. Overweight, obesity and gastric cancer risk: results from a meta-analysis of cohort studies. Eur J Cancer. 2009;45(16):2867–73.
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Chumbalkar, V., Fu, Z., Boguniewicz, A. et al. Gastric Lipohyperplasia Presenting as Gastric Polyposis: the First Case Report and Morphometric Study of Additional 127 Bariatric Specimens with a Proposal for Diagnostic Criteria. OBES SURG 29, 1805–1809 (2019). https://doi.org/10.1007/s11695-019-03740-8