title: Gastric lipoma presenting as a giant bulging mass in an oligosymptomatic patient: a case report.
abstract: BACKGROUND
  Lipomas of the gastrointestinal tract are a rare condition. Only 5% are of gastric origin, and this corresponds to 2% to 3% of all benign tumors of the stomach and less than 1% of all gastric neoplasms. It is our purpose to report an unusual presentation of a giant gastric lipoma in an oligosymptomatic patient and highlight the importance of discussing differential diagnosis in this situation. A review of the literature has shown that this is one of the largest gastric lipomas described.
  
  
  METHODS
  We describe a rare case of a benign gastric tumor with uncommon features in a 63-year-old Caucasian woman. She was admitted with abdominal discomfort, nausea, and upper abdominal fullness after eating. The lesion was suspicious of malignancy because of its dimension and central contrast enhancement on computed tomography. Conventional upper digestive endoscopy revealed a large bulging mass in the gastric posterior wall and three ulcerated areas. In this procedure, a technical limitation due to the location of the mass in the submucosa prevented an adequate biopsy from being obtained. The fragments obtained from the ulcers revealed nothing but necrotic mucosa. Our patient underwent a subtotal gastrectomy and D1 lymphadenectomy with a Roux-en-Y reconstruction. Macroscopic findings revealed a 12 × 8 × 6cm mass with a volume of 576cm3, and the histological pattern demonstrated well-differentiated mature adipose tissue surrounded by a fibrous capsule, confirming the diagnosis of gastric submucosal lipoma.
  
  
  CONCLUSIONS
  Gastric lipoma is a rare benign disease that eventually simulates a malignant tumor.
authors.affiliation: Pontifícia Universidade Católica de Campinas, Faculty of Medicine, Avenida John Boyd Dunlop - s/n°, Campinas, São Paulo, 13060-904, Brazil. gusta.nardini@gmail.com.
authors.forename: Francisco Américo Fernandes
authors.initials: FA
authors.lastname: Neto
authors.forename: Maria Cristina Furian
authors.initials: MC
authors.lastname: Ferreira
authors.forename: Luiz Carlos Nascimento
authors.initials: LC
authors.lastname: Bertoncello
authors.forename: André Amate
authors.initials: AA
authors.lastname: Neto
authors.forename: Wilson Chubassi
authors.initials: WC
authors.lastname: de Aveiro
authors.forename: Caroline Agnelli
authors.initials: CA
authors.lastname: Bento
authors.forename: Gustavo Nardini
authors.initials: GN
authors.lastname: Cecchino
authors.forename: Marco Antonio Mendes
authors.initials: MA
authors.lastname: Rocha