Clin Endosc > Volume 55(2); 2022 > Article
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Kim, Kim, and Kim: A Rare Cause of Subepithelial Tumor in the Gastric Fundus

Quiz

A 46-year-old woman presented with a gastric subepithelial tumor. The tumor was incidentally detected during a screening endoscopy. The tumor was located on the posterior wall of the gastric fundus, without any observable erosion or ulceration on its surface (Fig. 1A). When compressed using biopsy forceps, the tumor felt hard and partially fixed. On endoscopic ultrasonography, the tumor measured 0.8 cm in diameter and presented as a heterogeneously hypoechoic lesion in the submucosal layer (Fig. 1B). Examination of the specimen obtained from the endoscopic biopsy revealed only chronic gastritis. The patient underwent a follow-up endoscopy 2 years later, which revealed that the tumor size had increased (Fig. 1C). Therefore, traction-assisted endoscopic submucosal dissection was performed (Fig. 1D-F).
What is the most likely diagnosis?
 

NOTES

Conflicts of Interest: Gwnag Ha Kim is currently serving as a deputy editor in Clinical Endoscopy; however, he was not involved in the peer reviewer selection, evaluation, or decision process for this article. The authors have no potential conflicts of interest.
Funding
This work was supported by a clinical research grant from the Pusan National University Hospital in 2021.
Author Contributions
Conceptualization: Gwang Ha Kim
Investigation: Da Mi Kim, Kyungbin Kim
Supervision: GHK
Writing-review & editing: DMK, GHK, KK

Fig. 1.
(A) Initial endoscopy reveals a small subepithelial tumor on the posterior wall of the gastric fundus. (B) On endoscopic ultrasonography, the tumor presents as a heterogeneously hypoechoic lesion in the submucosal layer, measuring 0.8 cm in diameter. (C) On follow-up endoscopy 2 years later, the tumor has increased in size although no erosion or ulceration is noted. (D) Traction-assisted endoscopic submucosal dissection is performed. (E) The tumor is removed completely. (F) The inner surface of the resected specimen.
ce-2022-039f1.jpg
Fig. 2.
(A) Histopathological examination reveals spindle cell proliferation and infiltration of lymphocytes and plasma cells in the submucosal layer (hematoxylin & eosin stain, ×200). (B) The spindle cells are immunopositive for CD34, and immunonegative for c-kit, smooth muscle actin, and S-100 protein (CD34 stain, ×100).
ce-2022-039f2.jpg

REFERENCES

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2. Kawai A, Matsumoto H, Haruma K, et al. Rare case of gastric inflammatory fibroid polyp located at the fornix of the stomach and mimicking gastric cancer: a case report. Surg Case Rep 2020;6:292.
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3. Kim GH, Park DY. A rare cause of gastric subepithelial tumor. Clin Endosc 2020;53:377–378.
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4. Mavrogenis G, Herin M, Natale MD, Hassaini H. Resection of a gastric fibroid inflammatory polyp by means of endoscopic submucosal dissection: how deep is deep enough? Ann Gastroenterol 2016;29:380.
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