ENDOSCOPIC ULTRASOUND DIAGNOSIS OF UNUSUAL SUBEPITHELIAL TUMORS: CASE SERIES

• Published in: Ultrasound in medicine & biology Vol. 48; pp. S63 - S64
• Main Authors: Șerban, Robert-Emmanuel, Sacerdoțianu, Victor Mihai, Godeanu, Robert Cristian, Doica, Irina Paula, Ungureanu, Bogdan Silviu, Ciurea, Tudorel
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2022
• Subjects: aortic aneurysm; endoscopic ultrasound; Gastrointestinal subepithelial tumors; textiloma; aortic aneurysm; textiloma; Gastrointestinal subepithelial tumors; endoscopic ultrasound
• ISSN: 0301-5629; 1879-291X
• DOI: 10.1016/j.ultrasmedbio.2022.04.178

Subepithelial tumors (SETs) are generally asymptomatic and clinically insignificant and have malignant, borderline, and benign variants. Endoscopic ultrasound (EUS) is the most accurate method of diagnosing gastric subepithelial tumors with increased sensitivity and specificity. We present 2 cases misinterpreted as subepithelial tumors, with EUS shifting the therapeutic management. Case 1: A 63-year-old female, known with hepatitis C virus-related cirrhosis, who performed an upper digestive endoscopy describing in the gastric body a subepithelial lesion of about 2.5 cm, with normal covering mucosa, raising the suspicion of the stromal tumor. Case 2: A 54-year-old man, known for type II diabetes with insulin treatment, with acute pancreatitis in 2005 and cholecystectomy for cholelithiasis one year before. He was admitted to the Gastroenterology Department accusing pain in the epigastrium and right hypochondrium. On clinical examination, the abdomen was sensitive in the epigastrium and right hypochondrium, with a normal-looking postoperative scar. Case 1: EUS of upper digestive tract revealed on the posterior wall of the stomach, immediately below the eso-gastric junction a transonic mass of 4/4.3 cm, with Doppler signal inside which seemed to belong to the aorta, possible ascending aortic aneurysm. The patient was referred to a CT-angiography scan to confirm the diagnosis. Case 2: An inhomogeneous mass was observed on abdominal ultrasound, with transonic content and hyperechoic areas inside; Upper digestive endoscopy revealed within the gastric antrum, a subepithelial tumor mass of about 6 cm, with normal covering mucosa. EUS was performed and a tumor mass of 6 cm was visualized, starting from the own muscular level with liquid content and multiple hyperechoic masses inside, without Doppler signal. Suspicion of foreign body was raised and the patient was directed to surgery, which confirmed the diagnosis of textiloma. Although in both cases endoscopy suspected subepithelial tumors, EUS provided more information which changed the patient's management, thus emphasizing its potential when assessing gastric subepithelial lesions.