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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181e2c6f8
Image of the Month

Gastric Xanthelasma

Wetzler, Graciela MD*; Felix, Amy A MSN*; Lipton, Jeffrey F MD

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*Pediatric Gastroenterology and Nutrition, Maimonides Infants & Children's Hospital of Brooklyn, USA

Department of Pathology, Maimonides Medical Center, Brooklyn, NY, USA

Address correspondence and reprint requests to Graciela Wetzler, MD, Maimonides Infants & Children's Hospital of Brooklyn, 977 48th St, Brooklyn, NY 11219 (e-mail: Gwetzler@maimonidesmed.org).

Dr Wetzler is affiliated with Astra Zeneca, Wyeth, and Centocor; however, neither of these companies were involved in the research or drafting of article. Ms Felix and Dr Lipton report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 13-year-old girl presented with epigastric pain, nausea, and heartburn. The patient had normal physical examination and blood tests. Upper endoscopy revealed bile reflux, cobblestone mucosa, and small nodule with whitish cap at the fundus (Figs 1 and 2). Gastric biopsies showed foveolar hyperplasia and foamy macrophages in the lamina propria, consistent with Helicobacter pylori gastritis and xanthelasma (Fig. 3). The patient was treated for H pylori, but her parents refused a second upper endoscopy to determine whether the lesion disappeared.

Figure 1
Figure 1
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Figure 2
Figure 2
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Figure 3
Figure 3
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Xanthelasma, a benign lesion, is a rare finding in the adult population with only 1 case reported in a child. In adults, it is mainly found in the gastric mucosa and occasionally in the esophagus or duodenum (1). The lesion appears as a yellowish-whitish nodule or plaque, single or multiple, from 0.5 to 10.0 mm (2,3). Etiology is unknown, but gastric xanthelasmas are seen when there are other pathological changes, such as chronic and atrophic gastritis, intestinal metaplasia, and bile reflux. Studies in adults show that these lesions are highly associated with H pylori infection (4). Although these lesions are not at increased risk for gastric cancer, biopsies are recommended to differentiate them from gastric tumors (3). Follow-up should include upper endoscopy to better understand the behavior of these lesions.

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REFERENCES

1. Collins M, Olazagasti JC, Fitzgerald J. Gastric xanthomas in a child. J Pediatr Gastroenterol Nutr 1994; 19:444–447.

2. Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O, et al. Xanthelasmas of the upper gastrointestinal tract. J Gastroenterol 2004; 39:215–219.

3. Gursoy S, Yurci A, Torun E, et al. An uncommon lesion: gastric xanthelasma. Turk J Gastroenterol 2005; 6:167–170.

4. Isomoto H, Mizuta Y, Inoue K, et al. A close relationship between Helicobacter pylori infection and gastric xanthomas. Scand J Gastroenterol 1999; 3:346–352.

Copyright 2010 by ESPGHAN and NASPGHAN

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