Clin Endosc > Volume 53(3); 2020 > Article
Kim and Park: A Rare Cause of Gastric Subepithelial Tumor

Quiz

A 43-year-old woman presented with a gastric subepithelial tumor incidentally detected during screening endoscopy (Fig. 1A). On follow-up endoscopy 6 months later, the tumor was seen at the posterior wall of the lower body and had increased in size compared with measurements obtained from the previous endoscopy; however, no erosion or ulceration was noted (Fig. 1B). When pressed upon with biopsy forceps, the tumor was found to be hard and unmovable. On endoscopic ultrasonography, the tumor measured 1.5 cm and had a heterogeneously hypoechoic appearance in the deep mucosal and submucosal layers (Fig. 1C). An examination of the specimen obtained from endoscopic biopsy revealed only chronic gastritis. Because the size of the tumor had increased, suggesting malignancy, endoscopic submucosal dissection was performed (Fig. 1D).

What is the most likely diagnosis?

NOTES

Conflicts of Interest: The authors have no financial conflicts of interest.

Fig. 1.
(A) Initial endoscopy reveals a small subepithelial tumor at the gastric lower body. (B) On follow-up endoscopy 6 months later, the tumor has increased in size, but no erosion or ulceration is noted. (C) On endoscopic ultrasonography, the tumor is a 1.5 cm-sized, heterogeneously hypoechoic lesion in the deep mucosal and submucosal layers. (D) The resected specimen after endoscopic submucosal dissection.
ce-2020-134f1.jpg
Fig. 2.
(A) Histopathological examination reveals spindle tumor cells under myxoid stroma with lymphoplasmacytic infiltration among the tumor cells (hematoxylin and eosin, ×400). (B) The spindle cells are immunopositive for smooth muscle actin and vimentin, and immunonegative for chromogranin, S-100, C-kit, DOG1, and anaplastic lymphoma kinase (smooth muscle actin, ×200).
ce-2020-134f2.jpg

REFERENCES

1. Shi H, Wei L, Sun L, Guo A. Primary gastric inflammatory myofibroblastic tumor: a clinicopathologic and immunohistochemical study of 5 cases. Pathol Res Pract 2010;206:287-291.
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2. Cook JR, Dehner LP, Collins MH, et al. Anaplastic lymphoma kinase (ALK) expression in the inflammatory myofibroblastic tumor: a comparative immunohistochemical study. Am J Surg Pathol 2001;25:1364-1371.
crossref pmid
3. Park SG, Kim GH, Park HJ, Kahng DH, Lee BE, Park DY. [Case of an inflammatory myofibroblastic tumor of the duodenum]. Korean J Gastroenterol 2018;72:28-32.
crossref pmid
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