The lamina propria is expanded by large foamy cells containing a mixture of lipids, including cholesterol, neutral fat, low-density lipoprotein, and oxidized low-density lipoprotein.
Xanthomas present as small sessile lesions or a while mucosal nodule or plaque; the surrounding gastric mucosa shows chemical gastropathy here, but also some cases have Helicobacter and/or atrophic gastritis.
The macrophages contain bland small nuclei and pale cytoplasm. Rarely, these lesions need to be distinguished from granular cell tumor and signet ring cell carcinoma, MAI infection, and malacoplakia.
CD68 indicates the foamy cells are largely histiocytes.
Gastric xanthomas are incidental lesions detected as whitish-yellowish single or multiple small nodules or plaques during EGD. They are most commonly encountered in the stomach, followed rarely by the esophagus and duodenum.
Males are involved preferentially 3:1, and usually seen in adults in their sixties most commonly. Importantly, there is no relationship to cutaneous xanthomas or hyperlipidemia. Xanthomas are often seen in the setting of atrophic gastritis, although there are no symptoms related to the xanthomas themselves.