S4630 A Case of Gastric Angiolipoma Presenting With Iron-deficiency Anemia

Introduction: Angiolipomas are benign tumors composed of blood vessels and adipose tissue that are rarely found in the stomach. Only 5 other cases of gastric angiolipoma have been reported in the literature, 3 of which presented with gastrointestinal bleeding. Case Description/Methods: 67-year-old woman with hypertension, hyperlipidemia, type 2 diabetes, and hypertrophic cardiomyopathy was referred for anemia and leukocytosis. Initial hemoglobin was 4.8 g/dL, white blood cell count 43 × 103/uL, iron 40 ug/dL, iron saturation 10.8%, ferritin 18.7 ng/mL. Patient reported generalized weakness and dyspnea on exertion, following a coronavirus disease 2019 infection. She also noted intermittent melena and worsening constipation from baseline. Flow cytometry showed a new diagnosis of chronic lymphocytic leukemia (CLL). Computed tomography abdomen/pelvis showed a 3 cm homogenous fat-density lesion within the distal stomach; initial esophagogastroduodenoscopy (EGD) revealed a large, ulcerated gastric antrum mass without stigmata of recent bleeding. Pathology from a superficial biopsy of the mass was unremarkable. The patient was stabilized, and a subsequent EGD with endoscopic submucosal dissection was performed as an outpatient. The gastric mass was removed, and pathology revealed angiolipoma (4.7 cm × 3.6 cm × 1.5 cm). The patient had ongoing symptomatic anemia (iron 11, iron saturation 2.4%) after angiolipoma removal; repeat EGD showed a healing ESD scar with no other bleeding sources. Video capsule endoscopy and MR enterography have revealed no obvious sources of bleeding to date. Discussion: Diagnosis of gastric angiolipoma requires histopathologic evaluation, as its appearance may resemble that of other, more common benign and malignant neoplasms. Once the tumor is removed, there is a low likelihood of recurrence, however, follow-up EGD may be warranted to ensure proper healing. Gastric angiolipoma is a rare cause of gastrointestinal bleeding; in prior case reports, bleeding resolved with removal of the tumor. In this case, no evidence of tumor bleeding was directly observed and symptomatic iron deficiency anemia did not resolve with tumor removal. Close follow-up and a thorough evaluation for sources of gastrointestinal bleeding is warranted, despite identification and removal of an angiolipoma. There is no known connection between CLL and angiolipoma. CLL, however, is associated with increased angiogenesis through activation of VEGF, a growth factor implicated in the growth of angiolipomas, suggesting a possible link between the 2 conditions.