Gastric xanthomatosis: a rare finding in the paediatric age.

Background: Gastric xanthoma are rare benign lesions most frequently found in the antrum. They can be associated with inflammation of the gastric mucosa, especially in patients with chronic gastritis, Helicobacter pylori, intestinal metaplasia, bile reflux. Their etiology is nevertheless not completely known as they are rarely described. Just a few number of adult cases aging >35 years has been reported [1], whereas to our knowledge only one previous paediatric case was described as yet [2]. Specific aim: We report a rare paediatric case of gastric xanthomatosis, whose endoscopic follow-up demonstrates the evolution of lesions and their correlation with Proton Pump Inhibitors (PPI) treatment administered. Case Report: A 13 year old girl came to our attention for disphagia, chest burning, feeling of regurgitation and rumination after each meal. Neither abdominal pain, nor alteration in stool frequency were referred. The clinical assessment was normal, except for a mild decrease in body weight (from 25th to 10th percentile) with respect to the height (50th percentile). The general blood tests performed were all negative, gastro-panel included [3]. A first upper-GI tract endoscopy previously performed had identified two whitish kissing lesions with diameter of 0.3 cm surrounded by hyperhaemic mucosa, in the middle of the small gastric curve, and a mild hyperhaemic antral mucosa. The histologic examination demonstrated inactive chronic gastritis at the antrum as well as in the areas next to the two lesions; no Helicobacter pylori was detected. A therapeutic trial with PPI was suggested and performed for one month, with only partial remission of symptoms. Given a relapse of symptoms fifteen days after the suspension of the PPI treatment, we decided to perform at our Unit another upper-GI-tract endoscopy two months after the previous one, in order to evaluate the effect of the ongoing treatment on the gastric lesions. Six gastric lesions were found this time: they appeared as nodules and soft pseudo-polyps and measuring 0.5−1 cm, with a greyish-whitish top resembling a papilloma. The presence of bile reflux was observed. The histologic examination evidenced foamy histiocytes being compatible with gastric xanthoma. Discussion: It is important not to misrecognize the nature of these lesions, since they may present at endoscopy an ulcer-like aspect, so that an anti-acidic treatment could be therefore inappropriately prescribed. Taking biopsies during upper GI-endoscopy is thus fundamental to diagnose gastric xanthoma as well as to exclude gastric tumors. Reference(s) [1] Gravina AG, Iacono A, Alagia I, D’Armiento FP, Sansone S, Romano M. Image of the Month: Gastric xanthomatosis associated with gastric intestinal metaplasia in a dyspeptic patient. Dig Liv Dis 2009; 41: 765. [2] Wetzler G, Felix AA, Lipton JF. Image of the Month: Gastric Xanthelasma. Jour Ped Gastroenterol Nutr 2010; 51: 1. [3] Guariso G, Basso D, Bortoluzzi CF, Meneghel A, Schiavon S, Fogar P, Farina M, Navaglia F, Greco E, Mescoli C, Zambon CF, Plebani M. GastroPanel: evaluation of the usefulness in the diagnosis of gastroduodenal mucosal alterations in children. Clin Chim Acta 2009; 402(1−2): 54−60.