Gastric duplication cyst: rare cause of upper gastrointestinal bleeding in a young adult, with a review of literature

Duplication cyst along the alimentary canal is a congenital anomaly which is rare and usually incidentally found at endoscopy or radiological imaging. It can develop anywhere along the alimentary canal with only 4% occurrence in the stomach. Only few cases of gastric duplication cysts were reported to be symptomatic along with its complications. Diagnostic modalities include oesophageo-gastroduodenoscopy (OGDS), endoscopic ultrasound (EUS), computerized tomography (CT) scan and magnetic resonance imaging (MRI). However, the best option to confirm the diagnosis is complete resection of the lesion. We are reporting about a teenage girl whereby she presented with sudden episodes of hematemesis, which led to a syncopal attack. She also complained of intermittent central abdominal pain for a month prior to her presentation. Physical examination was unremarkable. However, her blood investigation showed a significant drop in hemoglobin. The patient had an endoscopy during which a submucosal lesion at the greater curvature was identified and the provisional diagnosis we had was a gastrointestinal stromal tumor (GIST). CT scan of the abdomen was also done showing an endoluminal cystic gastric lesion measuring approximately 2×2×2 cm. The lesion was confined to the stomach with no local infiltration of the adjacent structures. Decision was made to proceed with a laparoscopic wedge resection after outweighing the risk and benefits of surgery. Gastric duplication cyst is a rare anomaly. Despite its rarity, it should be included as a differential when we encounter a submucosal lesion due to its tendency for malignant transformation and other complications.

Endoscopic Submucosal Dissection for Resolution of a Symptomatic Pancreatic Rest in a Pediatric Patient: A Case Report and Literature Review

The pancreatic rest, aberrant, or heterotopic pancreas is a normal function pancreas found in the submucosal layer of the greater curvature of the gastric antrum and occasionally in the duodenum. Most of the patients are asymptomatic and the finding is usually incidental. We describe the case of a child with abdominal pain and history of recurrent ulcers that necessitated esophagogastroduodenoscopy and further evaluation with endoscopic ultrasound that confirmed a submucosal lesion consistent with a pancreatic rest. Endoscopic submucosal dissection was performed without complication, and complete symptom resolution was achieved after dissection of the pancreatic rest.

A Case of Tuberculosis Lymphadenitis Mimicking Gastric Tumor

Introduction: Solitary tuberculosis of the upper gastrointestinal tract is a rare pathology that usually mimics the clinical and radiological features of malignant tumors. A gastric subepithelial tumor is usually detected during diagnostic endoscopy. Stomach tuberculosis, in particular, can appear as a subepithelial tumor of the stomach wall. Several cases of gastric tuberculosis imitating subepithelial tumor gastric have been reported recently. Case report: We describe a case of a Patient with tuberculous lymphadenitis that mimics the submucosal gastric tumor. A 52-year-old female was admitted to our department; endoscopy revealed a submucosal compression or anterior submucosal lesion, erosive anterior gastropathy, and a fistulous orifice located in the bulb. The patient was diagnosed with a gastric tumor and Endoscopic ultrasound demonstrated a rounded antral lesion, hypoechogenic, not vascularized, that is distant from the gastric wall whose 5 layers appear of normal aspect. The patient was operated on for exploratory laparotomy. the biopsy was sent for frozen section examination that concluded to tuberculous intraperitoneal lymphadenitis. The patient received anti-tuberculosis treatment.Conclusion: Abdominal lymphadenitis tuberculosis is an uncommon situation which presents a dilemma for clinicians, as a great mimicker for a long list of differential diagnoses.

CASE REPORT ON RARE DE-DIFFERENTIATED GIST OF STOMACH OCCURRING DENOVO

We present a rare case of de-differentiated GIST. GIST being the most common mesenchymal tumor of alimentary canal is commonly reported. However, de-defferentiation of GIST is a rare phenomenon which may occur denovo or with imatinib therapy. A 57 year old female patient presented with generalized weakness and anemia. On evaluation, a submucosal lesion on the body of stomach along the greater curvature was identied on UGI endoscopy. On CECT scan of abdomen, polypoidal intraluminal mass was seen. After sleeve gastrectomy histopathological examination showed dedifferentiated GIST, stomach which was conrmed on IHC. The patient had no prior history of Imatinib therapy/ any chemotherapy. We present this case as de-differentiated GIST occurring denovo without prior imatinib therapy is rare and not much is known about its clinical course and prognosis of such cases.

Multiple caecal granular cell tumours—a case report

Granular cell tumours (GCTs) are generally benign neoplasms, which are believed to be of neural origin. They are uncommon in the gastrointestinal tract. They are rarely found in the colon and even more rarely found to be multiple. We present a case of a man who underwent a right hemicolectomy for a submucosal lesion and polyps and was found to have multiple nodules diagnosed as caecal GCTs with cellular atypia. While uncommon, this case shows it remains an important differential due to implications for patient management, given the often benign nature of disease.

Gastric Epithelioid Haemangioendothelioma: A Case Report

Objective: To report a case of gastric epithelioid haemangioendothelioma, given its low incidence. Introduction: Epithelioid haemangioendothelioma is a vascular neoplasm composed of epithelioid or histiocytoid cells with endothelial characteristics. They have a very low incidence of approximately one per one million and are usually asymptomatic with a difficult preoperative diagnosis. Case Report: This study reports the case of a 58-year-old woman with a history of chronic anaemia. She underwent an elective upper endoscopy with evidence of an ulcerated submucosal lesion in the gastric antrum. The histological examination performed over the endoscopic biopsies showed the vascular characteristic of the tumor and endosonography confirmed the submucosal origin of the lesion. After resective surgery, the tumor showed the histological and immunohistochemical features of the epithelioid haemangioendothelioma. Conclusion: Surgery in the form of wide excision seems to be the treatment of choice for this rare neoplasm in the absence of histological markers of malignant potential.

Endoscopic resection of a large submucosal tumor causing intermittent gastric outlet obstruction using a novel radiofrequency enabled device

Gastric lipomas are rare benign tumors and account for 1-3% of all benign gastric tumors. Majority of the gastric lipomas are asymptomatic and do not demand resection. However, large gastric lipomas may present with upper gastrointestinal bleeding and more rarely gastric outlet obstruction. Traditionally, surgery has been utilized for the management of giant gastric lipomas. More recently, endoscopic techniques are increasingly utilized for the resection of gastric submucosal lesions. Here we describe a case with large gastric lipoma who presented with symptoms suggestive of gastric outlet obstruction. Gastroscopy revealed a large (6 cm) submucosal lesion with a broad peduncle located in antrum. The tumor was prolapsing into duodenum thereby, completing occluding the pylorus. In this case, we performed endoscopic submucosal dissection using a novel, bipolar radiofrequency device. The dissection was completed without any complication.