Symptomatic gastric submucosal lipoma presenting with melena and iron-deficiency anemia in a 71-year-old male: a rare case report.

Introduction and importance: Gastric lipomas are rare, benign mesenchymal tumors composed of mature adipose tissue, accounting for less than 3% of all benign gastric neoplasms. They are typically asymptomatic but can occasionally present with gastrointestinal bleeding or obstruction when large. Due to their submucosal origin and nonspecific clinical features, preoperative diagnosis can be challenging. Case presentation: A 71-year-old male presented with fatigue, melena, and hypotension. Laboratory tests revealed iron deficiency anemia (hemoglobin 7.9 g/dL) and thrombocytopenia. Upper GI endoscopy showed a submucosal lesion of size 4 × 5 cm in the distal gastric body with a central depression and visible vessel, suggestive of GIST, but a biopsy was not performed due to the submucosal location and high suspicion of a mesenchymal tumor. CT confirmed a well-circumscribed submucosal mass. The patient underwent distal gastrectomy with gastrojejunostomy. Histopathology revealed a submucosal lipoma with tumor-free margins. Clinical discussion: Although gastric lipomas are usually asymptomatic, larger lesions can lead to mucosal ulceration and bleeding. In such cases, surgical resection remains the treatment of choice, providing both diagnostic confirmation and complete cure. Awareness of this rare cause of upper GI bleeding can help prevent misdiagnosis as malignant tumors, such as GIST. Conclusion: Gastric lipoma, while rare, should be considered in elderly patients presenting with unexplained GI bleeding or anemia. Complete surgical excision offers an excellent prognosis.