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.
