Diagnosis Of Gastric Submucosal Tumors Research Articles

Gastric glomus tumor with a rare presentation: a case report and review of the literature

Introduction and Importance: Gastric glomus tumors (GGT) are rare soft tissue tumors of the gastrointestinal tracts (GIT). It is somewhat challenging to establish the diagnosis of GGT and differentiate it from the more common submucosal neoplasms. Case Presentation: A 34-year-old female patient presented with upper gastrointestinal bleeding. Extensive workup including endoscopic ultrasonography (EUS) revealed a well-circumscribed isoechoic mass arising from the muscularis propria. Based on fine needle biopsy (FNB) findings, with H&E stains performed only initially, the mass was considered a neuroendocrine tumor (NET). Antrectomy with Billroth II anastomosis was performed. A microscopic and immunohistochemical studies of the resected specimen showed the cells to be positive for smooth muscle actin (SMA) making GGT the final diagnosis. Clinical Discussion: Of the 116 patients included in our analysis, 56.9% (n=66) were females and age group was between 41-64 years old in 63.8% (n=74) of the patients. About 55 cases (47.4%) had abdominal or epigastric pain or discomfort, which was the most frequent clinical symptom. In immunohistochemistry, SMA staining is present in 68.1% of the cases, underscoring its diagnostic significance. Laparotomy with wedge or partial gastrectomy was employed in 46.1% of the recorded cases. Due to malignant potential, long-term follow-up and monitoring are usually recommended. Conclusion: Despite the rarity of GGT, they should be included in the differential diagnosis of gastric submucosal tumors, with immunohistochemistry studies playing a major role in the diagnosis. Furthermore, a comprehensive evaluation of the literature in the past eight years was presented in a table.

Value of artificial intelligence with novel tumor tracking technology in the diagnosis of gastric submucosal tumors by contrast-enhanced harmonic endoscopic ultrasonography.

Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is useful for the diagnosis of lesions inside and outside the digestive tract. This study evaluated the value of artificial intelligence (AI) in the diagnosis of gastric submucosal tumors by CH-EUS. This retrospective study included 53 patients with gastrointestinal stromal tumors (GISTs) and leiomyomas, all of whom underwent CH-EUS between June 2015 and February 2020. A novel technology, SiamMask, was used to track and trim the lesions in CH-EUS videos. CH-EUS was evaluated by AI using deep learning involving a residual neural network and leave-one-out cross-validation. The diagnostic accuracy of AI in discriminating between GISTs and leiomyomas was assessed and compared with that of blind reading by two expert endosonographers. Of the 53 patients, 42 had GISTs and 11 had leiomyomas. Mean tumor size was 26.4mm. The consistency rate of the segment range of the tumor image extracted by SiamMask and marked by the endosonographer was 96% with a Dice coefficient. The sensitivity, specificity, and accuracy of AI in diagnosing GIST were 90.5%, 90.9%, and 90.6%, respectively, whereas those of blind reading were 90.5%, 81.8%, and 88.7%, respectively (P=0.683). The κ coefficient between the two reviewers was 0.713. The diagnostic ability of CH-EUS results evaluated by AI to distinguish between GISTs and leiomyomas was comparable with that of blind reading by expert endosonographers.

Diagnosis of gastric submucosal tumors and estimation of malignant risk of GIST by endoscopic ultrasound. Comparison between B mode and contrast-harmonic mode

Backgroundstandard B-mode EUS assessment and EUS-guided tissue acquisition present sub-optimal diagnostic yield in the differential diagnosis of gastric submucosal tumors (SMTs). Aimsto evaluate the performances of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) to differentiate gastric SMTs and predict malignancy risk of gastrointestinal stromal tumors (GIST). Methodsa retrospective analysis was performed retrieving consecutive patients with gastric SMTs who underwent EUS between 2009 and 2014. Patients with available EUS video recordings and histological diagnosis were included. De-identified videos were presented to experts who made a diagnosis on B-mode EUS and CH-EUS. Resultsfifty-four patients (29 female, 64-year-old) were included. Final diagnoses were 40 GISTs (8 high-grade), 9 leiomyomas, 5 rare SMTs. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the differential diagnosis of GIST were 95.0% vs. 85.0%, 57.1% for both techniques, and 85.2% vs. 77.8%, respectively. The sensitivity, specificity, and accuracy of B-mode and CH-EUS for the estimation of the malignancy GISTs risk were 62.5% vs. 100%, 83.3% vs. 82.1%, and 78.9% vs. 86.1%, respectively. ConclusionsCH-EUS showed better diagnostic performance than B-mode EUS in differentiating leiomyomas and risk stratification of GIST. When considering high-grade GISTs, the addition of CH-EUS allowed an improvement in diagnostic accuracy.

A case of gastric granular cell tumor.

We herein describe an extremely rare case of gastric granular cell tumor (GCT). The gastric submucosal tumor showed a central tiny depression on the surface with a molar tooth-like appearance on esophagogastroduodenoscopy. Our case highlights that gastric GCT should be considered as differential diagnosis of gastric submucosal tumors.

Analysis of Clinical Features and Endoscopic Ultrasonography in the Diagnosis of Gastric Submucosal Tumors

To explore the clinical features and endosonographic (EUS) features of gastric submucosal tumors, the connection of submucosal tumor features and pathological features are analyzed to increase the awareness of submucosal tumors. This study is based on 237 cases of gastric mucosal lesions from March 2015 to March 2019. Endoscopic ultrasonography was performed to record the size and origin of the lesions and to make the preliminary qualitative diagnosis of the lesions, where endoscopic resections have 186 cases. According to the actual lesion resection in endoscopic ultrasonography, the origin level of SMTs and the coincidence rate of endoscopic ultrasonography diagnoses are judged. Therefore, endoscopic ultrasonography has high localization, characterization, and differential diagnosis value for gastric mucosal lesions. Diagnosis of gastric mucosal lesions under endoscopic ultrasonography is helpful for the choice of endoscopic resection surgical method.

Examine the Availability and Safety of Mucosal Cutting Biopsy Technique for Diagnosis of Gastric Submucosal Tumor.

Objectives Differentiating gastrointestinal stromal tumor (GIST) from other submucosal tumors (SMTs) is important in diagnosing SMT. GIST is an immunohistological diagnosis that cannot be made from images alone. Tissue sampling of tumor sites is thus becoming increasingly important. In this study, the utility and associated complications of mucosal cutting biopsy (MCB) for gastric SMTs were investigated. Methods This was a case series study. The subjects were patients aged ≥20 years old in whom an SMT was seen on esophagogastroduodenography and who underwent MCB between January 2012 and December 2016. Patient information, endoscopy findings, gastric SMT size, pathological diagnosis, and other information were gathered from medical records. The SMT size was the maximum diameter that could be visualized on EUS. The pathological diagnosis was made with hematoxylin-eosin staining, with immunostaining added to diagnose GIST. The endpoint was the histopathological diagnostic yield. Risk assessment using the Miettinen classification and modified Fletcher classification was also done for GISTs treated with surgery. Results The mean tumor diameter was 15.4 mm. The tumor diameter was ≥20 mm in seven patients and <20 mm in 23 patients. The tissue-acquiring rate was 93.3%. A histological diagnosis could not be made in two patients. The only complication was that bleeding required endoscopic hemostasis during the procedure in one patient, but no subsequent bleeding or no postoperative bleeding was seen. Conclusions MCB is an appropriate and safe procedure in the diagnosis of gastric SMTs. Many hospitals will be able to perform MCB if they have the environment, including skills and equipment, to perform endoscopic submucosal dissection.

An Uncommon Gastric Submucosal Tumor With Mucosal Erosion

A 54-year-old man with no prior medical history was referred to our hospital for a gastric lesion. An upper endoscopy showed a subepithelial tumor with a central erosion measuring 35 mm in size, located on the posterior wall of the gastric body (Figure A). Biopsy specimens from the depressed and elevated areas showed no neoplastic changes. Endoscopic ultrasonography showed a multicystic heterogeneous component (Figure B). Contrast-enhanced computed tomography showed that some of the cystic components showed contrast (Figure C). T2-weighted magnetic resonance imaging (MRI) also showed multicystic and heterogeneous tissue, and T1-weighted contrast-enhanced MRI showed cystic wall enhancement in the tumor. We successfully performed en bloc resection of the tumor using endoscopic submucosal dissection. The patient was discharged without complication. Histologically, dilated pseudopyloric glands and smooth muscle proliferation were observed in the submucosal layer with inverted and expansive growth (Figure D). Immunohistochemical analysis indicated that those glands were Mucin (MUC)10 and MUC2 negative, and MUC5AC and MUC6 positive. The mucosal layer was defective at the center of the lesion. The horizontal and vertical margins were negative. There was no sign of atypia. The pathologic diagnosis was a gastric hamartomatous inverted polyp (GHIP). GHIPs are rare gastric polyps that account for less than 1% of all gastric tumors.1Iida M. Yao T. Watanabe H. et al.Fundic gland polyposis in patients without familial adenomatosis coli: its incidence and clinical features.Gastroenterology. 1984; 86: 1437-1442Abstract Full Text PDF PubMed Scopus (63) Google Scholar There have been few reports of endoscopic submucosal dissection of GHIP,2Odashima M. Otaka M. Nanjo H. et al.Hamartomatous inverted polyp successfully treated by endoscopic submucosal dissection.Intern Med. 2008; 47: 259-262Crossref PubMed Scopus (22) Google Scholar and this case includes MRI findings. Although GHIP can mimic gastric intestinal stromal tumors,3Mori H. Kobara H. Tsushimi T. et al.Two rare gastric hamartomatous inverted polyp cases suggest the pathogenesis of growth.World J Gastroenterol. 2014; 20: 5918-5923Crossref PubMed Scopus (9) Google Scholar such as in this case, the findings of endoscopic ultrasound, computed tomography, and MRI are relatively specific. The possibility of GHIP should be considered in the differential diagnosis of gastric submucosal tumors because this can help direct therapeutic decisions. GHIP may have a potential risk of malignancy.4Oh S.J. Oh C.A. Kim D.H. et al.Adenocarcinoma derived from gastric hamartomatous polyps.J Korean Surg Soc. 2011; 81: 419-422Crossref PubMed Scopus (9) Google Scholar Although there has been no report of recurrence to our knowledge, annual surveillance has been performed.

Histological diagnosis of gastric submucosal tumors: A pilot study of endoscopic ultrasonography-guided fine-needle aspiration biopsy vs mucosal cutting biopsy.

To compare the usefulness of endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNAB) without cytology and mucosal cutting biopsy (MCB) in the histological diagnosis of gastric submucosal tumor (SMT). We prospectively compared the diagnostic yield, feasibility, and safety of EUS-FNAB and those of MCB based on endoscopic submucosal dissection. The cases of 20 consecutive patients with gastric SMT ≥ 1 cm in diameter. who underwent both EUS-FNAB and MCB were investigated. The histological diagnoses were gastrointestinal stromal tumors (n = 7), leiomyoma (n = 6), schwannoma (n = 2), aberrant pancreas (n = 2), and one case each of glomus tumor, metastatic hepatocellular carcinoma, and no-diagnosis. The tumors' mean size was 23.6 mm. Histological diagnosis was made in 65.0% of the EUS-FNABs and 60.0% of the MCBs, a nonsignificant difference. There were no significant differences in the diagnostic yield concerning the tumor location or tumor size between the two methods. However, diagnostic specimens were significantly more frequently obtained in lesions with intraluminal growth than in those with extraluminal growth by the MCB method (P = 0.01). All four SMTs with extraluminal growth were diagnosed only by EUS-FNAB (P = 0.03). No complications were found in either method. MCB may be chosen as an alternative diagnostic modality in tumors showing the intraluminal growth pattern regardless of tumor size, whereas EUS-FNAB should be performed for SMTs with extraluminal growth.

Ectopic Pancreas in the Stomach Successfully Resected by Endoscopic Submucosal Dissection

A 32-year-old Japanese man presented with a gastric submucosal tumor. Esophagogastroduodenoscopy showed a sessile submucosal tumor measuring approximately 10 mm in diameter on the greater curvature of the gastric antrum. Endoscopic ultrasonography examination revealed a solid tumor with a diameter of 11.8 mm, which was located in the deep mucosal and submucosal layers. The internal echogenicity was homogenous and hypoechoic. Biopsy examinations were performed twice but were not diagnostic since only the intact mucosal layer was obtained. The patient was subsequently diagnosed with ectopic pancreas in the stomach by endoscopic submucosal dissection (ESD). This case underscores the usefulness of the ESD technique for the pathological diagnosis of gastric submucosal tumors.

Discrepancy in diagnosis of gastric submucosal tumor among esophagogastroduodenoscopy, CT, and endoscopic ultrasonography: a retrospective analysis of 93 consecutive cases

Evidences on diagnostic ability of esophagogastroduodenoscopy (EGD), CT, and endoscopic ultrasonography (EUS) for gastric submucosal tumor (SMT) are insufficient. For investigating a suitable diagnostic strategy, we retrospectively investigated diagnostic accuracy of EGD and CT for SMT, in comparison to EUS findings. Ninety-three consecutive lesions in which gastric SMT was suspected by EGD were investigated by EUS from March 2009 to June 2011, including 55 lesions evaluated also by CT 4months before or after EUS. Frequency of possibly malignant SMTs as a detection rate of EGD, and sensitivity and specificity of CT in detection of SMT were retrospectively analyzed. Factors influencing the ability for CT to detect SMT were also investigated. EUS revealed possibly malignant SMT in 60 cases (64.5%). In 32 out of 55 cases, possibly malignant SMT was suspected by CT. Sensitivity and specificity of CT was 80.6% and 84.2%, respectively. The mean size of possibly malignant SMT detected and not detected by CT was 27.4 and 11.0mm, respectively, with a statistically significant difference (p=0.0001). This study elucidated that approximately one-third of suspected SMTs by EGD might not need clinical care. EUS for suspected SMTs is indispensable for extracting possibly malignant SMTs from others, and CT may be insufficient as an alternative to EUS in detecting especially small ones.

A case of hepatocellular carcinoma showed the usefulness of endoscopic ultrasound-guided fine needle aspiration cytology using the cell block technique for differential diagnosis of gastric submucosal tumor

A case of hepatocellular carcinoma showed the usefulness of endoscopic ultrasound-guided fine needle aspiration cytology using the cell block technique for differential diagnosis of gastric submucosal tumor

Role of EUS and MDCT in the diagnosis of gastric submucosal tumors according to the revised pathologic concept of gastrointestinal stromal tumors

Gastric submucosal tumors (SMTs) consist of various lesions arising from the deep layers of the stomach. Gastrointestinal stromal tumors (GISTs) are undoubtedly the commonest malignant SMTs of the stomach, and therefore the attitude towards the general diagnostic approach for GISTs defines the extended diagnostic plan for SMTs. Two recent consensus meetings were assembled concerning the classification and therapeutic plans for GISTs. These meetings shed light upon the need for the modification of the current role of imaging modalities, including endoscopic ultrasound (EUS) and computed tomography (CT). According to the revised concepts of GISTs, the most important and plausible current role of imaging for the diagnostic approach of gastric SMTs is to differentiate GISTs from other gastric SMTs. This review discusses the newly established diagnostic role of radiology according to the revised classification of GISTs and provides the differential diagnoses based on EUS and CT findings.

Diagnosis of gastric submucosal tumors using endoscopic ultrasound guided fine needle aspiration

4574 Background: Submucosal lesions are incidentally detected on barium meal study or endoscopy. The differential diagnosis of them includes a variety of neoplasms, inflammation, and extraluminal c...

Laparoscopic Resection of Clinically Suspected Gastric Stromal Tumors

Gastrointestinal stromal tumors (GISTs) account for 5% of all gastric tumors. Preoperative diagnosis is relatively difficult because biopsy samples are rarely obtained during fibergastroscopy. Surgical radical resection is the gold standard treatment, allowing pathologic study for both diagnosis and prognosis. Laparoscopic resection has become an alternative to the open approach, but long-term results are not well known. The aim of this study is to report experience with laparoscopic resection, placing special emphasis on preoperative diagnosis and describing long-term results. A retrospective analysis was made of all patients undergoing a laparoscopic resection for clinically suspected gastrointestinal stromal tumors between November 1998 and August 2006 at 2 tertiary hospitals. The medical records of all participants were reviewed regarding surgical technique, clinicopathologic features, and postoperative long-term outcome. Laparoscopic gastric resection was attempted in 22 patients (13 women and 9 men) with a mean age of 66.7 years (range, 29-84 years). One patient had 2 gastric tumors. Tumor localization was upper gastric third in 6 patients, mid-gastric third in 7, and distal third in 10. Surgical techniques were transgastric submucosal excision (n = 1), wedge resection (n = 13), partial gastrectomy with Y-en-Roux reconstruction (n = 6), and total gastrectomy with Y-en-Roux reconstruction (n = 2). Two patients (9.1%) required conversion to the open procedure because of tumor size. Postoperative morbidity was delayed gastric emptying in 3 patients. Median postoperative stay was 6 days (range, 4-32 days). Pathologic and immunohistochemical study confirmed gastrointestinal stromal tumors in 18 cases. The other 4 cases were adenomyoma, hamartoma, plasmocytoma, and parasitic tumor (anisakis). Median tumor size was 5.6 cm (range, 2.5-12.5 cm) in cases of gastrointestinal stromal tumors. Malignant risk of gastrointestinal stromal tumors assessed according to mitotic index and size was low (n = 8), intermediate (n = 6), or high (n = 4). After a median follow-up of 32 months (range, 1-72 months), there was 1 case of recurrence of GIST. Definitive preoperative diagnosis of gastric submucosal tumors is frequently difficult. The laparoscopic approach to surgical treatment of these tumors seems safe and is associated with acceptable intermediate-term results, especially in cases of gastrointestinal stromal tumors.

Resection of hepatic tumors simulating a gastric submucosal tumor: report of two cases

The patient was a 36-year-old male. A protruding lesion adjacent to the cardia of the stomach was detected by upper gastrointestinal series, and the diagnosis of gastric submucosal tumor was entertained by upper gastrointestinal endoscopy and abdominal computed tomography (CT) (Fig. 1), while endoscopic ultrasound (EUS) findings were not inconsistent with a muscular layer-derived tumor (Fig. 2). Laparoscopic partial resection of the stomach was therefore scheduled. The observation of the abdominal cavity revealed a tumor growing from the edge of the lateral segment of the liver (Fig. 3), for which laparoscopic partial resection of the liver was performed. He developed no complications and was discharged 5 days after surgery.

Endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of gastrointestinal stromal tumors in the stomach.

For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degree of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as leiomyosarcomas have received further study with immunohistochemical staining and have been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study, we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiating their degrees of malignancy. From January 1997 to March 2002, 21 cases of gastric GISTs were diagnosed from the immunohistochemical staining of specimens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with low-grade malignancy) underwent EUS-FNAB preoperatively, and were examined further: their EUS-FNAB specimens were submitted for additional immunohistochemical testing. The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coinciding with the staining results of the resected specimens. The MIB-1 labeling indices in specimens of high-grade malignancy were significantly higher than those of low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling index of more than 5% was a high-grade malignancy, the diagnostic accuracy was 85.7%. The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining, the procedure may indicate GIST prognosis and influence decisions regarding therapeutic strategies.

7232 Diagnosis of gastric submucosal tumors by endoscopic ultrasonography (eus); only image vs. eus-guided fine needle aspiration biopsy.

Introduction:Endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNAB) for gastric submucosal tumors (SMTs) is controversial. Although it is generally believed that the EUS diagnosis of SMTs is reliable, and the rate obtained from histological samples from SMTs by EUS-FNAB is admittedly not so high, we are sometimes at a loss whether we should recommend a patient to undergo surgical resection or merely be observed. Therefore, we compared simple EUS diagnosis by experienced EUS doctors and results of EUS-FNAB. Subjects and methods: From March 1994 to May 1999 we performed EUS-FNAB in twenty-three patients with gastric SMT. All SMTs were over 3 cm. We gave five senior EUS doctors 2 EUS images of each SMT, and had them answer questionnaires regarding the diagnosis of SMT and treatment options. These doctors have experienced EUS for over five years. They judged the diagnosis of SMT and surgical resection or follow-up. Initially, we used a radial scanner GF-UM20 (Olympus Optical Co. Ltd.) for diagnosis. EUS-FNAB was performed using Pentax FG-32UA or FG-36UX convex array endosonography. Results: 1. Twenty-three patients with SMT were average 57.7 years old, 14 men and 9 women. SMTs were 14 leiomyomas, 4 leiomyosarcomas, 4 aberrant pancreases, and 1 ectopic gastric gland (mean size 33.4mm). 2. Simple EUS diagnosis was about 50% accurate by EUS senior doctors. 3. Diagnosis in 17 out of 23 SMTs was in accordance among experienced doctors („ 80%). Six of 17 SMTs were misdiagnosed. Of these 6 SMTs we obtained 4 correct diagnoses by EUS-FNAB. The six out-of-accordance cases included 3 aberrant pancreases. 4. Even when the doctors diagnosed leiomyoma, they recommended surgical resection because of a diameter over 50 mm and rapid growth in a short time. Conclusions: 1. FNA was useful for the relatively large solid tumor with cystic structure, for example, leiomyoma, leiomyosarcoma, and aberrant pancreas. 2. However, FNA diagnosis did not influence the choice of surgery or follow-up for tumors over 50 mm in diameter.

Endoscopic ultrasonography is useful for diagnosis of gastric submucosal tumor

Endoscopic ultrasonography is useful for diagnosis of gastric submucosal tumor

Guillotine Needle Biopsy as a Supplement to Endosonography in the Diagnosis of Gastric Submucosal Tumors

The presumptive diagnosis of gastric submucosal tumors can be made by endoscopic ultrasonography (EUS) but histological confirmation is still required. A special guillotine biopsy device (Flexi-Temno) which enables collection of adequate submucosal samples by the endoscopic approach was therefore evaluated. After visualization by EUS the guillotine needle biopsy was performed in 21 patients with submucosal tumors of the stomach. There were 2 failures in 2 patients with leiomyomas. The diagnosis suggested by EUS was confirmed by guillotine biopsy in 17 cases. Guillotine biopsy detected 2 cases of unsuspected leiomyosarcoma which were confirmed surgically. In cases of solid submucosal tumors confirmed on EUS, the guillotine needle biopsy enables a definitive histologic diagnosis. Thus malignancies can be detected when EUS findings are not significant.

Endoscopic ultrasonography in the diagnosis of gastric submucosal tumor

Endoscopic ultrasonography contributed to a correct diagnosis in 24 of 25 patients with gastric submucosal tumor, including 10 extrinsic compressions and 14 intraparietal growths. Leiomyoma and lipoma were easily recognized. In one case, an unusual group of gastric varices was clearly differentiated from a pedunculated polyp prior to polypectomy. In gastric submucosal tumors, endoscopic ultrasonography can greatly reduce the need for aggressive and risky biopsy techniques or exploratory laparotomy.