Gastric Nodule Turned Rare Gastric Xanthoma

Gastric nodules (polyps) are a common finding in routine endoscopic procedures. Uncommonly, gastric nodules turn out to be lipid-filled waxy lesions called xanthomas. In this case report, we discuss a rare incidence of a gastric nodule turning out to be a xanthoma in a 50-year-old male patient. Xanthomas of the GI tract occur by the exact mechanism as their cutaneous counterpart and are relatively uncommon. A 50-year-old male with a past medical history of gastroesophageal reflux disease (GERD), hyperlipidemia, and constipation presented to our hospital with a chief complaint of epigastric discomfort, bloating, and gastric reflux, all starting the night before admission. Gastroenterology was consulted, and they performed an esophagogastroduodenoscopy (EGD) during the admission due to the patient's age and long history of GERD. EGD showed mild gastritis and xanthelasma. The patient's upper GI symptoms improved. All other workups were negative. Right upper quadrant (RUQ) US performed showed hepatic steatosis. With lifestyle changes, the patient's alkaline phosphatase returned to normal. After a month of medical management, GERD symptoms reoccurred. Repeat EGD was performed, and xanthomatous aggregates were shown, suggesting xanthoma. Upper GI symptoms continued. Gastric xanthomas are a rare occurrence. Most xanthomas in the upper GI tract are located in the stomach and have various causes. The risk for malignancy is low; these lesions are commonly confused for malignancies, prompting biopsy and histology. Overall, xanthomas are rare findings with a sinister look but benign results.