Gastric xanthoma: histologic similarity to signet ring cell carcinoma

Gastric xanthomas (GX) are pale yellow nodules or plaques, usually less than 3 mm in size, in the gastric mucosa. They are frequently found in groups, most often along the lesser curvature and pyloric regions. They consist of liquid-laden histiocytes in the lamina propria occasionally extending into the submucosa. There is no correlation between GX and hypercholesterolemia. The lesion is of little significance, except as it may be misdiagnosed as carcinoma. We present two cases of GX, one initially thought histologically to be a signet ring cell carcinoma. With the paucity of reports of GX in the medical literature and the potential for incorrect diagnosis, we emphasize the importance of recognition and accurate histologic diagnosis of GX.