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Gastric xanthomas are single or multiple yellowish-white small nodules or plaques in the gastric mucosa. Microscopically they consist of macrophage-derived foam cells full of lipids. However, because of their benign nature, there are few reports of gastric xanthomas in the literature and their clinical significance still remains unknown. In this study, we studied 131 elderly cases (42 males and 89 females) with the average age of 75.6 +/- 12.3 (S.D.) years old who were examined gastroendoscopically. The endoscopic finding of gastric xanthomas was observed in 17 males (40.5%) and in 23 females (25.8%). Gastric xanthomas tended to increase with age, and the frequency was highest in the seventies (40.0%). Of the xanthoma cases, 42.5% had a solitary xanthoma, and 17.5% had more than 5 xanthomas. More than 70% of xanthomas were observed in antral and pyloric regions. There was no difference in serum lipids between the cases with and without xanthomas. Gastric mucosa biopsied from around xanthomas showed moderate to severe atrophic change of gastric glands in most cases (89%). Hyperplasia of gastric-pit epithelia and intestinal metaplasia were also often observed. However, there was no correlation between gastric xanthomas and small round cell infiltration in the gastric mucosa. It was concluded that gastric xanthomas in the elderly arise from the mucosa with atrophic change in most cases, which may have a disturbance of local lipid metabolism, and that the presence of gastric xanthomas may be a marker of the pathological aging change of gastric mucosa.

Cerebrotendinous Xanthomatosis (CTX) is a rare familial disease characterized by tendon-xanthomas, cataracts, progressive cerebellar ataxia, dementia and an elevation of serum cholestanol with normal levels of cholesterol. Although the pathogenesis of CTX is not fully understood, increment of cholestanol is suggested one of the major metabolic derangements of the disease. Recently, the LDL-apheresis has been developed as a new therapeutical equipment in the field of hyperlipidemia and been widely used to reduce the levels of LDL-cholesterol by selective LDL adsorption. From the point of view that cholestanol is involved mainly in LDL-cholesterol (1.019 less than d less than 1.063), we used this LDL-apheresis in the aim of reducing the cholestanol in 58 years old woman with typical sign and symptoms of CTX. The levels of serum cholestanol and cholesterol before the treatment with LDL-apheresis, were 10.7 micrograms/ml and 175 mg/dl respectively. Also the ratio of cholestanol/cholesterol indicated 0.63. By the first procedure of apheresis, the level of cholestanol was markedly decreased to 5.2 micrograms/ml (50%). Several LDL-apheresis treatments were carried out once a month. During 5 months treatments, neurological deterioration was arrested, dementia which included disorientation and recent-memory loss, cleaned a little. Although the xanthomas did not decrease in size, this patients was better oriented to person, place, time and was able to speak rationally, 2nd her cerebellar dysfunction revealed improvement. From our new experiments-we believe that the LDL-apheresis offers the strong hope of preventing the progress on cerebrotendinous xanthomatosis.