What Kind of Gastric Tumor Is This?

Oscar M. Crespin, MD; Ali Kagan Coskun, MD; Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD

Disclosures

January 15, 2014

Case Presentation and Imaging

A 68-year-old woman initially presented with an incidental submucosal mass of the lesser curve visible on CT. Approximately 1 year later, she developed periprandial obstructive symptoms, and imaging was repeated.

The second CT scan showed a solid mass that appeared to be within the gastric wall, beginning at the gastroesophageal junction down the lesser curvature. The longest transverse or diagonal dimension was 5.4 cm, and the tumor seems to have grown 4-5 mm since the previous scan the year before (Figure 1).

Figure 1. CT showing a solid mass within the gastric wall in the lesser curvature (arrows).

Endoscopic ultrasonography confirmed the size of the tumor; informed the solid characteristic of the trilobar submucosal mass; and was very useful to guide core needle biopsies that were negative for CD19/CD117, CD34, and S100 and positive for desmin and alpha-smooth muscle actin, all of which were consistent with the smooth-muscle differentiation of a leiomyoma (Figure 2).

Figure 2. Endoscopic ultrasonography showing a solid trilobar submucosal mass and core needle biopsy (arrow).

If this tumor had been a GIST, the treatment would have been esophagogastrectomy formally for margins, given its involvement of the gastroesophageal junction.

However, because it was a leiomyoma, laparoscopic enucleation was performed to relieve the obstruction but maintain the competency of the gastric cardia and gastroesophageal junction.

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