Endoscopic resection of giant gastrointestinal stromal tumor at the esophagogastric junction: a case report

Abstract Background Gastrointestinal stromal tumors (GISTs) at the esophagogastric junction are rare and its treatment is complicated and challenging. Endoscopic resection has advantages with less complications compared to open and laparoscopic surgery. Case presentation We report a 33-year-old male patient who was admitted to our department complaining of abdominal fullness for 20 days. A huge submucosal tumor at the esophagogastric junction was found by upper gastrointestinal endoscopy. We successfully resected the lesion through endoscopic submucosal excavation without complications, which was pathologically confirmed to be a GIST. The patient was discharged 5 days after operation and has been doing well, and there was no recurrence 8 months after the operation. Conclusion ESE is possibly an effective and minimally invasive method of giant esophagogastric junction stromal tumor.

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Submucosal tunneling and en bloc endoscopic resection facilitates laparoscopic transgastric removal of a large GI stromal tumor at the esophagogastric junction

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.02.025 ◽

2016 ◽

Vol 84 (1) ◽

pp. 179-180 ◽

Cited By ~ 2

Author(s):

Payal Saxena ◽

Mohamad El Zein ◽

Martin Makary ◽

Vivek Kumbhari ◽

Mouen A. Khashab

Keyword(s):

Endoscopic Resection ◽

Esophagogastric Junction ◽

Stromal Tumor ◽

En Bloc ◽

Gi Stromal Tumor

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A Pancreatic Inflammatory Myofibroblastic Tumor with Spontaneous Remission: A Case Report with a Literature Review

Diagnostics ◽

10.3390/diagnostics9040150 ◽

2019 ◽

Vol 9 (4) ◽

pp. 150 ◽

Cited By ~ 2

Author(s):

Hiroyuki Matsubayashi ◽

Katsuhiko Uesaka ◽

Keiko Sasaki ◽

Seitaro Shimada ◽

Kazunori Takada ◽

...

Keyword(s):

Inflammatory Myofibroblastic Tumor ◽

Gastrointestinal Endoscopy ◽

Fine Needle Aspiration Biopsy ◽

Submucosal Tumor ◽

Spontaneous Remission ◽

Needle Aspiration ◽

Eosinophil Infiltration ◽

Upper Gastrointestinal Endoscopy ◽

Pancreas Head ◽

Upper Gastrointestinal

The inflammatory myofibroblastic tumor (IMT) is a rare tumor that can develop in any systemic organ. Its features are generally benign, but it often resembles malignancies and is treated surgically. Our patient was an 82-year-old female complaining of abdominal discomfort. Computed tomography demonstrated a 5 cm, ill-enhanced mass at the pancreas head. Upper gastrointestinal endoscopy revealed a duodenal submucosal tumor with apical erosion. Endoscopic ultrasonography (EUS) demonstrated a heterogeneous, low-echoic pancreas mass without clear margins. Fine-needle aspiration biopsy (FNAB) demonstrated spindle myofibroblastic tissues with lymphoplasmacyte and eosinophil infiltration, confirming an IMT diagnosis. Surprisingly, the tumor spontaneously regressed in one month without medication. Histological diagnosis using EUS-FNAB is essential for the rare pancreatic solid tumor like IMT.

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Intrahepatic cholangiocarcinoma with gastric infiltration misdiagnosed as gastric submucosal tumor

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa359 ◽

2020 ◽

Vol 2020 (11) ◽

Author(s):

Shunichi Ito ◽

Yutaka Takahashi ◽

Takuji Yamada ◽

Yosuke Kawai ◽

Kei Ohira

Keyword(s):

Adjuvant Chemotherapy ◽

Liver Tumors ◽

Submucosal Tumor ◽

Proximal Gastrectomy ◽

Upper Gastrointestinal Endoscopy ◽

Primary Liver Tumors ◽

Regional Lymphadenectomy ◽

Multiple Bone Metastases ◽

Lesser Curvature ◽

Upper Gastrointestinal

Abstract Intrahepatic cholangiocarcinomas (ICC) are rare primary liver tumors. In few cases, they may invade nearby organs and present as extrahepatic growths, leading to poor prognosis. We report a case of a 78-year-old man who presented with fatigue. An upper gastrointestinal endoscopy was performed to find a cause for his anemia, which showed a submucosal tumor with delle at the lesser curvature of the gastric cardia. A computed tomography revealed a low-density tumor of diameter 70 mm at the cardia. It appeared to infiltrate the liver directly. We performed lateral hepatectomy, proximal gastrectomy and lymphadenectomy. The pathological findings revealed an ICC with gastric infiltration. Although adjuvant chemotherapy was administered, 12 months postoperatively, the patient developed pain and multiple bone metastases for which palliative radiation was initiated. The guidelines for lymphadenectomy and adjuvant chemotherapy in such cases are unclear. Appropriate regional lymphadenectomy and adjuvant chemotherapy can improve the prognosis of such patients.

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A Case of Gastrointestinal Stromal Tumor That Underwent Endoscopic Ultrasound-Guided Aspiration with a 25-Gauge Biopsy Needle

Case Reports in Gastroenterology ◽

10.1159/000443269 ◽

2016 ◽

Vol 10 (1) ◽

pp. 173-178

Author(s):

Minoru Tomizawa ◽

Fuminobu Shinozaki ◽

Yasufumi Motoyoshi ◽

Takao Sugiyama ◽

Shigenori Yamamoto ◽

...

Keyword(s):

Gastrointestinal Stromal Tumor ◽

Endoscopic Ultrasound ◽

Submucosal Tumor ◽

Gastric Wall ◽

Stromal Tumor ◽

Upper Gastrointestinal Endoscopy ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Doppler Image ◽

Hypoechoic Lesion

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed to obtain specimens for pathological analysis. For this procedure, 19-gauge (19G), 22-guage (22G), and 25-guage (25G) needles are available. The needles are classified into aspiration type and biopsy type. A 56-year-old woman underwent upper gastrointestinal endoscopy that showed a 38-mm-diameter submucosal tumor. The elevated lesion was diagnosed as a submucosal tumor of the stomach. Contrast-enhanced computed tomography showed a low-density area on the luminal surface of the gastric wall, which was covered with a thin layer of gastric mucosa. EUS showed a hypoechoic lesion in the submucosal layer. Color Doppler image showed a pulsating vascular signal extending into the center of the hypoechoic lesion from the periphery. EUS-FNA was performed with a 25G biopsy needle. The specimen tissue consisted of spindle-shaped cells. The cells were positive for CD117 and CD34. The submucosal tumor was diagnosed as a gastrointestinal stromal tumor.

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Status of the Gastric Mucosa with Endoscopically Diagnosed Gastrointestinal Stromal Tumor

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2014/429761 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Kouichi Nonaka ◽

Shinichi Ban ◽

Yoshimitsu Hiejima ◽

Rei Narita ◽

Michio Shimizu ◽

...

Keyword(s):

Gastric Mucosa ◽

Gastrointestinal Stromal Tumor ◽

Submucosal Tumor ◽

Stromal Tumor ◽

Upper Gastrointestinal Endoscopy ◽

Submucosal Tumors ◽

Gastric Gists ◽

Mri Features ◽

H Pylori ◽

Ct And Mri

Background. Since gastrointestinal stromal tumor (GIST) is a mesenchymal submucosal tumor, the endosonographic, CT, and MRI features of gastric GISTs have been widely investigated. However, the GIST-bearing gastric mucosa status has not been reported. Objective. To characterize the GIST-bearing gastric mucosa status in terms of the degree of inflammation and atrophy, assessed endoscopically. Subjects and Methods. The subjects were 46 patients with submucosal tumors (histologically proven gastric GISTs) who had undergone upper gastrointestinal endoscopy in our hospital between April 2007 and September 2012. They were retrospectively evaluated regarding clinicopathological features, the endoscopically determined status of the entire gastric mucosa (presence or absence and degree of atrophy), presence or absence and severity of endoscopic gastritis/atrophy (A-B classification) at the GIST site, and presence or absence of H. pylori infection. Results. Twenty-three patients had no mucosal atrophy, but 17 and 6 had closed- and open-type atrophy, respectively. Twenty-six, 5, 12, 1, 1, and 1 patients had grades B0, B1, B2, B3, A0, and A1 gastritis/atrophy at the lesion site, respectively, with no grade A2 gastritis/atrophy. Conclusion. The results suggest that gastric GISTs tend to arise in the stomach wall with H. pylori-negative, nonatrophic mucosa or H. pylori-positive, mildly atrophic mucosa.

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PS02.247: TWO CASES OF NEUROENDOCRINE CARCINOMA OF ESOPHAGOGASTRIC JUNCTION

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.247 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 193-193

Author(s):

L E O Yamada ◽

Shinji Ohki ◽

Daisuke Ujiie ◽

Takeshi Tada ◽

Hiroyuki Hanayama ◽

...

Keyword(s):

Esophagogastric Junction ◽

Gastrointestinal Endoscopy ◽

Pathological Examination ◽

Medical Institute ◽

Upper Gastrointestinal Endoscopy ◽

Muscularis Mucosa ◽

Cell Type ◽

Paraaortic Lymph Nodes ◽

Upper Gastrointestinal

Abstract Background Neuroendocrine cell carcinoma (NEC) of the esophagogastric junction is rare and usually has a very poor prognosis. Methods Here we present two cases of NEC occurred in the esophagogastric junction. Results Case 1 A 50-year-old man was admitted to the introduction origin medical institute with an abdominal pain and dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed the diffuse proliferation of relatively homogeneous tumor cell with chromatin-enriched nuclear and immunohistologically, the tumor cells were positive for Chromogranin A, CD56, AE1/3. MIB-1 index was 80%, we diagnosed neuroendocrine carcinoma (small cell type). TNM Stage was GE, Type 3, cT4, cN1, cM0 cStage IIIB (ENETS TNM classification) He had undergone total gastrectomy and lower esophagectomy with transhiatal approach and 2 field of lymph node dissection. Pathological examination revealed NEC component developed under the muscularis mucosa, differentiated adenocarcinoma localized upper the muscularis mucosa and Chromogranin A positive cells were scattered inside. Pathological findings showed NEC (MIB-1 72.5%) with tub1, 70 × 56 mm, pT3 pN1(7/36), stage IIIB (HER2 score0). Adjuvant chemotherapy using S-1 was started, but the follow up CT showed recurrence in mediastinum, left subclavian and paraaortic lymph nodes 7 months after surgery. S-1 followed by CPT-11 + CDDP, CT showed the shrinkage of paraaortic lymph nodes metastasis. The patient alive for 55 months without any evidence ofprogression being continued chemotherapy. Case 2 A 57-year-old man was admitted to the introduction origin medical institute with dysphagia. Upper gastrointestinal endoscopy revealed a type 2 tumor at the esophagogastric junction, and the pathological examination showed NEC (small cell type). CT and PET revealed mediastinal lymph node metastasis, aortic invasion and adrenal metastasis. TNM stage was NEC, EG, cT3, cN1, cM1 cStage IV. We performed a systemic chemotherapy with CPT-11 + CDDP, the evaluation of treatment effect after 5 course chemotherapy revealed partial response. However the patient underwent the endoscopic stent graft due to stenosis, and died due to progressive disease 18months after chemotherapy induction. Conclusion We reported here two cases of NEC occurring in the esophagogastric junction. It's clinical behavior remains unclear and the treatment strategy for NEC of esophagogastric junction is not established. Further investigation of accumulated cases of this rare entity is necessary. Disclosure All authors have declared no conflicts of interest.

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