Rectal Xanthoma: A Case Report of a 56-Year-Old Female Patient

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Xanthomas are raised, waxy-looking, yellowish lesions resulting from accumulation of cholesterol and fats. Their most common location is the skin. However, though rare, they can occur in the gastrointestinal (GI) tract. Typically, they are usually found incidentally on colonoscopic examinations, appearing as red polyps or occasionally as yellowish- white in formations with a size of 1-3 mm. They can be misdiagnosed for lipomas. Although most commonly they are completely asymptomatic, some cases were reported with obstructive symptoms such as pain, abdominal distension and vomiting. Histologically, rectal xanthomas consist of aggregates of foamy macrophages in the lamina propria, which are negative for mucin and cytokeratin but positive for CD68 immunostain. Case Description/Methods: We present a case of a 55-year-old gentleman with past medical history of diabetes type 2, hypertension, hyperlipidemia, and obesity, who presented to undergo screening colonoscopy. At the time of presentation, the patient exhibited no GI symptoms or complaints, and laboratory test results were within normal limits. Colonoscopy was done and it showed diverticulosis throughout the colon, and multiple diminutive polyps, along with an 8 mm polyp that was found in the rectum. Biopsy was taken and histopathological evaluation of the 8mm polyp showed collections of foamy cells in the lamina propria suggestive of mucosal xanthoma, without dysplastic changes. The patient was evaluated 2 weeks after the colonoscopy and was doing well with no complaints or symptoms, and will be followed based on the regular colonoscopy surveys. Discussion: Some studies were focusing on the relationship between dyslipidaemia and the development of rectosigmoid xanthomas.one study highlighted the role of lipid metabolism abnormalities as the underlying cause of xanthomas with evidence suggesting that treating hyperlipidaemia can lead to the resolution of gastric xanthomas in some cases. Conversely, other studies found no significant association between gastric xanthomas and diabetes mellitus, hypercholesterolemia, or skin lesions. Further research is needed to explore the intricate relationship between xanthomas and lipid metabolism, shedding light on potential therapeutic avenues and management strategies (see Figure 1).

Volume

119

Issue

10

First Page

S1978

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