Upper gastrointestinal bleeding as an unusual manifestation of localized Ménétrier's disease with an underlying lipoma: A case report

Abstract

Background: Ménétrier's disease is a rare condition characterized by enlarged gastric folds, usually located in the whole body and fundus of the stomach. This report presents an unusual case of localized Ménétrier's disease elevated by a submucosal lipoma and thus looking like a polypoid mass and causing an episode of upper gastrointestinal bleeding. The mass was successfully removed with endoscopic submucosal dissection.

Case summary: Esophagogastroduodenoscopy was performed on a 76-year-old male patient after an episode of upper gastrointestinal bleeding, manifesting as fatigue and melena. A large polypoid mass (4 cm × 1 cm) with enlarged mucosal folds was found in the body of the stomach, between the lesser curvature and posterior wall. A small ulcer at the distal end of the mass was identified as the source of the bleeding. Biopsy was negative for neoplasia. Computed tomography showed a submucosal lesion beneath the affected mucosa, most likely a lipoma. The mass was removed en bloc with tunneling endoscopic submucosal dissection. Final pathology determined that the mass included Ménétrier's disease and a submucosal lipoma. The patient was scheduled for follow-up esophagogastroduodenoscopy.

Conclusion: Localized Ménétrier's disease can coexist with a submucosal lipoma creating a polypoid mass with risk of bleeding.

Keywords: Case report; Endoscopic submucosal dissection; Gastrointestinal hemorrhage; Ménétrier’s disease; Submucosal lipoma; Submucosal tunneling endoscopic resection.

Figure 1

Polypoid mass found in the stomach during esophagogastroduodenoscopy. A: A mass (4 cm × 1 cm) with enlarged mucosal folds in the body of the stomach between the lesser curvature and posterior wall; B: A small ulcer at the distal end of the mass.

Figure 2

Computed tomography of the abdomen with contrast enhancement. A: A submucosal lesion in the stomach. Mean density of -89 HU suggested a submucosal lipoma; B: Length, 4.86 cm; C: Width, 1.96 cm.

Figure 3

Resection of the mass via tunneling endoscopic submucosal dissection. A: A tunnel was created in the submucosal layer beneath the mass; B: Dissection was performed on both sides of the tunnel; C: Muscular defects were closed, and mucosal margins approximated with clips.

Figure 4

Resected specimen. A: Immediately after resection, enlarged gastric folds were observed on the surface; B: Intersected specimen in the Pathology Department. Yellow tissue of the submucosal lipoma was observed.

Figure 5

Histological changes in Ménétrier’s disease. A: Low magnification; B: Cystic dilation of deep glands with foveolar hyperplasia; C: Foveolar hyperplasia with tortuous glands; D: Foveolar hyperplasia with dilation of the glands and oxyntic atrophy.

Figure 6

Submucosal lipoma and accompanying changes in the course of Ménétrier’s disease. A: Low magnification; B: Foveolar hyperplasia; C: Foveolar hyperplasia with a corkscrew morphology; D: Foveolar hyperplasia with tortuous glands and mild inflammation in lamina propria.

Figure 7

Histological changes in the course of Ménétrier’s disease: Foveolar hyperplasia, proliferation of muscularis mucosae and mild inflammation of lamina propria.

Figure 8

The mucosa with changes in the course of Ménétrier’s disease and the adjacent submucosal lipoma. The lipoma was adjacent to the mucosa without crossing its borders. A: Low magnification; B, C and D: Representative images taken at high magnification.