Giant gastric lipoma mimicking well-differentiated liposarcoma

Gastric lipoma is a rare tumor, accounting for only 5% of gastrointestinal tract lipomas and less than 1% of all gastric tumors. Histological diagnosis is usually easy. However, the tumor may sometimes undergo significant inflammatory changes leading to a difficult differential diagnosis with well-differentiated liposarcoma. Authors report the case of a 51-year-old man, presenting with epigastralgia of recent onset. Physical exam was unremarkable. Endoscopy revealed a large, ulcerated, submucosal, and antral tumor. CT scan showed an antral mass with fat attenuation. The patient underwent a total gastrectomy. Macroscopic examination identified in the antral wall a 9-cm, well-circumscribed, nodular lesion, with a greasy cut surface. On histological examination, the tumor was composed of a mature adipocytes proliferation, showing significant variation in cell size, associated to some lipoblasts. Nuclei were sometimes large, irregular, neither with hyperchromasia nor mitosis. Diagnosis of a well-differentiated liposarcoma was suspected and hybridization. The diagnosis of lipoma was made. Twelve months after surgery, the patient is doing well. In conclusion, differentiating benign from malignant fatty tumors is sometimes difficult in morphologic features. In these cases, cytogenetic procedures are the only means for an accurate diagnosis

[Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helcobacter pylori]

It's a prospective study leaded between September 1997 and July 1999 [23 months] in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one months later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realized. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomization in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concerning activity 80%, intestinal metaplasia 12%, inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus [p< 0.005]. After treatment, a significative fall of Helicobacter pylori and activity and atrophy was established, contrariety to intestinal metaplasia and chronic inflammation witch are persisted. The prevalence of follicular gastritis was 57%. The better rate of ulcer cicatrisation and Helicobacter pylori eradication was respectively of 79% and 66% in group 1 treated by omeprazol, amoxicillin, metronidazol by comparison with the others 3 groups [p< 0.005]