Los xantomas gástricos están asociados con lesiones malignas y premalignas / Gastric Xanthoma is Associated with Malignant ad Premalignant Lesions

RESUMEN

Los xantomas gástricos son lesiones encontradas incidentalmente en la endoscopia digestiva alta. Consisten en la acumulación de lípidos en la mucosa gástrica. Estas lesiones se han reportado en serie de casos asociadas con metaplasia o atrofia y en reportes de casos vinculados con cáncer gástrico; sin embargo, no se han realizado estudios comparativos que busquen comprobar esta asociación. El objetivo de este trabajo es evaluar si los pacientes con xantomas tienen más lesiones malignas (displasia o cáncer) o condiciones premalignas (atrofia o metaplasia). Materiales y métodos: se trata de un estudio retrospectivo de casos y controles realizado en el Hospital El Tunal, en pacientes que fueron sometidos a endoscopia de vías digestivas altas (EVDA) para evaluación de dispepsia. A cada caso de xantoma se le asignó un control de endoscopia realizado el mismo día por el síntoma de dispepsia y escogido de manera aleatoria. Todos los pacientes fueron sometidos a biopsias para evaluación histológica y por infección de Helicobacter pylori. Resultados: en total se reclutaron 186 pacientes que cumplieron los criterios de inclusión, ya que tenían indicación de EVDA porque cursaban con dispepsia no investigada. Fueron comparados dos grupos de pacientes el primero, con hallazgo de xantomas gástricos en la endoscopia (n = 90) y el segundo, sin estos hallazgos (n = 96). El promedio de edad de los pacientes con xantomas fue de 57, 4 versus 38,3 del grupo control, 35% sexo masculino versus 35,6%, respectivamente. Los xantomas fueron únicos en el 72%. La mayoría se ubicó en el antro (53%), cuerpo (32%), antro o cuerpo (10%) y fondo (5%). En los pacientes sin xantomas no se presentaron casos de displasia (0%), mientras que en el grupo con xantomas, 5,5% de los pacientes lo presentó (5 casos), de los cuales 2 fueron de bajo grado y 3, de alto grado. El 66% del grupo xantoma versus el 85% del control tenía infección por H. pylori. Tres pacientes presentaron ...

ABSTRACT

Gastric xanthoma lesions, which involve lipid accumulation in the gastric mucosa, are found incidentally during upper endoscopy. These lesions have been reported in series of cases associated with metaplasia or atrophy and in reports that link them to gastric cancer, but no analysis has been done to date that examines the possible connections among these associations. The aim of this study was to evaluate whether patients with xanthoma have more malignant lesions (dysplasia or cancer) or premalignant conditions (atrophy or metaplasia). Materials and Methods: This is a retrospective case-control study that was conducted in the Hospital El Tunal among patients who underwent upper endoscopies for evaluation of dyspepsia. Participants were chosen at random from among patients who had symptoms of dyspepsia. Each participant underwent endoscopy to check for xanthoma on the same day. All patients had biopsies taken and were assessed histologically for H. pylori infection. Results: The study enrolled a total of 186 patients who met the inclusion criteria of requiring upper endoscopy due to symptoms of dyspepsia. as was indicated field-work one EVDA that with uninvestigated dyspepsia were recruited. Two groups of patients were compared one included 90 patients who were diagnosed with xanthoma through gastric endoscopy (n = 90), and another group which consisted of 96 patients in whom no symptoms of xanthoma were found. The average age of the patients with xanthoma was 57.4 years while the average age of the control group was 38.3 years. 35% of the xanthoma group were male while 35.6% of the control group were male. 72% of the patients in the xanthoma group had only one lesion 53% were located in the antrum, 32% were located in the corpus, 10% in the antrum or corpus, and 5% in the fundus. Among patients without xanthomas, there were no cases of dysplasia (0%) while 5.5% of the patients with xanthomas (5 cases) developed dysplasia. Two were low ...