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Gastrointestinal Lipid Island / Xanthoma

Definition

  • Accumulation of lipid laden cells in the lamina propria of the GI tract

Alternate / Historical term

  • Xanthelasma

Diagnostic Criteria

  • Small gastric lesions
    • <15 mm, most <5 mm
    • Very rare lesions in esophagus or intestines
  • Lamina propria expanded by a pavement-like infiltrate of foamy cells
    • Virtually always involves the upper lamina propria
      • May extend into submucosa
    • Foveolae and glands displaced
    • Uniform population of bland cells
      • Central nuclei
      • No mitotic activity
    • Finely vacuolated foamy cytoplasm
    • Foam cells positive for histiocytic markers

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting :December 5, 2009

Supplemental studies

  • Histochemical stains of foam cells
    • PAS negative
    • Sudan Red positive (unprocessed tissue)
  • Immunohistologic stains of foam cells
    • Oxidized LDL positive (one case)
    • Some histiocytic markers positive
      • KP1, KiM1p, cathepsin D 100%
      • Others weak to negative
        • MAC387, lysozyme, alpha 1 antitrypsin
    • Keratin negative
  • Electron microscopy demonstrates lipid
    • Predominantly in histiocytes
    • Also in most other cells present including smooth muscle and plasma cells

Differential Diagnosis

  • Diffuse carcinoma
    • Atypical eccentric nuclei
    • Usually PAS/D positive
    • Keratin positive
  • Whipple disease
    • PAS/D positive
  • Atypical myobacteria
    • Acid fast positive

Clinical

  • Very common, up to 58% in autopsy study
  • Appears only to occur in abnormal stomachs
    • Chronic and atrophic gastritis, intestinal metaplasia, bile refllux are frequently present
  • No need to treat or resect lipid islands
    • Underlying gastric disorder should be treated
  • Not associated with hyperlipidemia

Bibliography

  • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
  • Kaiserling E, Heinle H, Itabe H, Takano T, Remmele W. Lipid islands in human gastric mucosa: morphological and immunohistochemical findings. Gastroenterology. 1996 Feb;110(2):369-74.
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