Xanthoma
Gregory Y. Lauwers, MD
Key Facts
Etiology/Pathogenesis
Helicobacter pylori
Common in operated stomach
Unknown etiology in many cases
Clinical Issues
Seen in 0.4-6% of endoscopies of nonoperated patients
Most commonly on lesser curvature
Yellowish nodule or plaque
May be multiple
10x more common after Billroth 2 resection
Microscopic Pathology
Aggregates of foamy lipid-laden histiocytes
Limited inflammation
Ancillary Tests
Positive histiocytic markers (e.g., CD68) and negative epithelial markers (e.g., AE1/AE3)
 Hematoxylin & eosin shows gastric xanthoma. Notice the subepithelial collection of bland foamy histiocytes underneath the surface epithelium. Several cells resemble signet-ring cells. |
 Hematoxylin & eosin shows a high-power view of bland foamy histiocytes, typical of xanthoma. The cells display a finely bubbly cytoplasm with round, inconspicuous nuclei. Mitoses are absent. |
TERMINOLOGY
Synonyms
Xanthelasma
Definitions
Collections of lipid-laden histiocytes within gastric mucosa
ETIOLOGY/PATHOGENESIS
Infectious Agents
Helicobacter pylori
Bile Reflux
Common in operated stomach
Metabolic
Hypercholesterolemia
Others
Cause is unknown in most cases
CLINICAL ISSUES
Epidemiology
Incidence
Relatively common
Seen in 0.4-6% of endoscopies of nonoperated stomachs
10x more common after Billroth 2 resection
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