Duodenal spindle cell lipoma: an uncommon cause of gastrointestinal bleeding – a case report

We present the case of a 60-year-old woman who was admitted to the emergency room with a two-day history of black stools and asthenia. She denied hematemesis. Her blood tests revealed iron deficiency anemia (Hb 7.4 g/dL). Upper endoscopy identified a pedunculated polypoid lesion with congested mucosa and superficial erosions, arising from the duodenal bulb and extending into the third portion of the duodenum. This lesion was suggestive of a subepithelial lesion, presumably responsible for gastrointestinal bleeding (shown in Fig. 1). Endoscopic ultrasound identified the lesion on the third layer of the duodenal wall, maintaining a clear interface with the fourth layer with well-defined and regular borders. The peduncle was hypoechoic and had blood vessels inside it, while the head of the lesion was hyperechoic and had blood vessels inside it (shown in Fig. 2.a & b & c). The lesion was excised by endoloop-assisted snare polypectomy (shown in Fig. 3. a & b & c and Fig. 4). Histological examination revealed spindle cell lipoma (SCL) (shown in Fig. 5. a & b & c). Clinical follow-up was performed six months after lesion excision. Spindle cell lipoma (SCL) is a morphologically distinct subtype of lipoma with internal vascularity There are few reports of their occurrence in the gastrointestinal tract, and they rarely appear on the duodenal wall [1]. Histologically, SCLs are characterized by a combination of mature adipose cells and small, uniform spindle cells set against a background of fibrous stroma (acidophilic collagen fibers) with myxoid changes. Spindle cells typically express CD34 (95%–100%) and are negative for S-100 and smooth muscle actin (SMA) [2]. SCL infrequently occurs in the gastrointestinal tract and rarely manifests as gastrointestinal bleeding. In the literature, only two cases of gastrointestinal bleeding caused by a duodenal SCL have been reported [3,4]. SCL generally has a benign clinical course. In spindle cell lipomas arising in typical anatomical locations, such as the neck and back, the local recurrence rate is approximately 2–3% after complete excision [5]. The recurrence rate of duodenal spindle cell lipoma has not been specifically described in the medical literature, likely due to its rarity in this location.There is no standardized or guideline-based follow-up protocol after excision of duodenal SCL. In asymptomatic patients, follow-up can be individualized, with endoscopic evaluation reserved for those who develop new symptoms.