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Gastric subepithelial lesion complicated with abscess: Case report and literature review

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World Journal of Gastroenterology 2015年第20期21卷 6398-6403页

作者： Sung Bum Kim Myung Jin Oh Si Hyung Lee Department of Internal Medicine Yeungnam University College of Medicine

Gastric abscess is a localized pyogenic inflammation of the gastric wall, which is a rare form of suppurative gastritis. The rarity of gastric abscess may be associated with the difficulty of early diagnosis and high mortality as a result. In general, subepithelial lesions (SELs) of the stomach are incidentally detected during the course of upper endoscopy without specific clinical symptoms and signs. However, some gastric SELs present rarely as a form of hemorrhage, obstruction, perforation, and abscess. Here we report a 45-year-old man with gastric SEL presenting as a gastric abscess, which was diagnosed as an ectopic pancreas of the stomach, along with a review of the literature. Although gastric SEL presenting as an abscess is known as a serious and life-threatening lesion, the patient made a complete recovery through surgical resection as well as medical treatment.

关键词： Suppurative gastritis Gastric abscess subepithelial lesion Ectopic pancreas Endoscopicultrasound

Esophageal subepithelial lesion diagnosed as malignant gastrointestinal neuroectodermal tumor

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World Journal of Gastroenterology 2015年第18期21卷 5739-5743页

作者： Sung Bum Kim Si Hyung Lee Mi Jin Gu Department of Internal Medicine Yeungnam University Hospital Department of Pathology Yeungnam University Hospital

A 21-year-old male visited our hospital with a complaint of aggravating dysphagia and odynophagia for a few *** showed huge bulging mucosa with an intact surface causing luminal narrowing at 35 cm from the incisor *** ultrasonography showed an about 35 mm sized irregular margined in-homogenous hypoechoic lesion with an obscure layer of *** ultrasonography fine needle aspiration revealed spindle cell proliferation without immunoreactivity for CD117,SMA,and *** patient underwent excision of the subepithelial lesion at the distal *** pathologic examination of the specimen,the tumor was composed of short fascicles of oval to spindle cells with eosinophilic and clear cytoplasm and vesicular *** tumor cells were positive for S-100 and SOX10and negative for CD117,SMA,HMB-45,melan-A,cytokeratin,and *** split-apart signal was detected in EWSR1 on FISH,suggesting a malignant gastrointestinal neuroectodermal *** the time of writing,the patient is on radiation therapy at the operated site of esophagus and doing well,with no recurrence for three *** gastrointestinal neuroectodermal tumor is a rare gastrointestinal tumor with features of clear cell sarcoma,without melanocytic differentiation,and shows a poor *** is the first reported case of malignant gastrointestinal neuroectodermal tumor arising as subepithelial lesion in the esophagus.

关键词： subepithelial lesion Esophagus Malignant gastrointestinal neuroectodermal tumor Ewing sarcoma break point region 1 gene Fluorescence in situ hybridization

A feasible modified biopsy method for tissue diagnosis of gastric subepithelial tumors

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World Journal of Gastroenterology 2013年第29期19卷 4752-4757页

作者： Jung Ho Kim Jun-Won Chung Minsu Ha Min Young Rim Jong Joon Lee Jungsuk An Yoon Jae Kim Kyoung Oh Kim Kwang An Kwon Dong Kyun Park Yeon Suk Kim Duck Joo Choi Department of Internal Medicine Gachon University Gil Medical Center Incheon 405-760 South Korea Department of Pathology Gachon University Gil Medical Center Incheon 405-760 South Korea

AIM: To evaluate the diagnostic yield and safety of a modified technique for the histological diagnosis of subepithelial tumors (SETs). METHODS: A retrospective review of patients who underwent a modified technique for the histological diagnosis of gastric SETs, consisting of a mucosal incision with a fixed flexible snare (MIF) and deep-tissue biopsy under conventional endoscopic view, from January 2012 to January 2013 was performed. Eleven patients with gastric SETs 10-30 mm in diameter and originating from the third or fourth layer on endoscopic ultrasonography were included. RESULTS: The mean age was 59.8 (range, 45-76) years, and 5 patients were male. The mean size of the SETs was 21.8 (range, 11-30) mm. The number of biopsy specimens was 6.3 (range 5-8). The mean procedure time was 9.0 min (range, 4-17 min). The diagnostic yield of MIF biopsies was 90.9% (10/11). The histological diagnoses were leiomyoma (4/11, 36.4%), aberrant pancreas (3/11, 27.3%), gastrointestinal stromal tumors (2/11, 18.2%), an inflammatory fibrinoid tumor (1/11, 9.1%); one result was non-diagnostic (1/11, 9.1%). There were six mesenchymal tumors; the specimens obtained in each case were sufficient for an immunohistochemical diagnosis. There was no major bleeding, but one perforation occurred that was successfully controlled by endoscopic clipping. CONCLUSION: The MIF biopsy was simple to perform, safe, and required a shorter procedure time, with a high diagnostic yield for small SETs.

关键词： subepithelial tumors Stomach Biopsy Endoscopy Diagnostic techniques

Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer

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World Journal of Gastroenterology 2015年第32期21卷 9503-9511页

作者： Yu Zhang Li-Ping Ye Xin-Li Mao Department of Gastro-enterology Taizhou Hospital of Zhejiang Province Wenzhou Medical College

Minimally invasive endoscopic resection has become an increasingly popular method for patients with small(less than 3.5 cm in diameter) gastric subepithelial tumors(SETs) originating from the muscularis propria(MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.

关键词： Gastric subepithelial tumors Endoscopic treatment

Duodenal subepithelial hyperechoic lesions of the third layer: Not always a lipoma

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World Journal of Gastrointestinal Endoscopy 2013年第10期5卷 514-518页

作者： Pedro C Figueiredo Pedro Pinto-Marques Evelina Mendona Pedro Oliveira Maria Brito David Serra Gastroenterology Department Hospital Garcia de OrtaAvenida Torrado da Silva Pathology Department Hospital da Luz Avenida Lusíada no100 Pathology Department Hospital Garcia de OrtaAvenida Torrado da Silva Gastroenterology Department Hospital da LuzAvenida Lusíada no100

Endoscopic ultrasonography is the most accurate procedure for the evaluation of subepithelial lesions. The finding of a homogeneous, hyperechoic, well-delimited lesion, originating from the third layer of the gastrointestinal tract(submucosa) suggests a benign tumor,generally lipoma. As other differential diagnoses have not been reported, echoendoscopists might not pursue a definitive pathological diagnosis or follow-up the patient. This case series aims to broaden the spectrum of differential diagnosis for duodenal hyperechoic third layer subepithelial lesions by providing four different and relevant pathologies with this echoendoscopic pattern.

关键词： Endoscopic ultrasonography Endoscopic ultrasound-guided fine needle aspiration Duodenum subepithelial tumor Lipoma

Hybrid natural orifice transluminal endoscopic surgery in gastric subepithelial tumors

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World Journal of Gastrointestinal Endoscopy 2013年第9期5卷 428-432页

作者： Jun Heo Seong Woo Jeon Department of Internal Medicine Kyungpook National University School of Medicine

Diagnosis of gastric subepithelial tumor(SET) has shown a rapid increase ***,until now,endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagnosis of SET,the most important modality for diagnosis and treatment of SETs is complete resection such as endoscopic or surgical ***,endoscopic resection or laparoscopic wedge resection alone also has some *** resection is difficult to perform in cases of gastric SET located within deep portion of the gastric layer or a relatively large(larger than 25 mm diameter).On the other hand,gastric SET in a difficult location,such as the gastroesophageal junction or pyloric ring is challenging for laparoscopic surgical *** hybrid natural orifice transluminal endoscopic surgery(NOTES) technique is a combined method,including the advantages of both laparoscopic resection and endoscopic resection for gastric *** method may be performed safely with reasonable operation times,less bleeding,and adequate resection margin and regardless of tumor *** particular,in the case of a difficult location for resection,such as the esophagogastric junction or pyloric ring,hybrid NOTES is currently believed to be an ideal treatment method.

关键词： subepithelial tumor Hybrid natural orifice transluminal endoscopic surgery Endoscopic ultrasound

Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography

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World Journal of Radiology 2010年第8期2卷 289-297页

作者： Hiroki Sakamoto Masayuki Kitano Masatoshi Kudo Division of Gastroenterology and Hepatology Department of Internal MedicineKinki University School of MedicineOsaka-Sayama 589-8511Japan

Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging *** can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic *** echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood ***,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th *** is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using *** the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic *** lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when ***,EUSFNA plays an important role in the clinical management of subepithelial *** improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial

关键词： Endoscopic ultrasonography Submucosal tumor subepithelial tumor

Management of gastric subepithelial tumors:The role of endoscopy

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World Journal of Gastrointestinal Endoscopy 2016年第11期8卷 418-424页

作者： Su Young Kim Kyoung Oh Kim Division of Gastroenterology Department of Internal MedicineGachon UniversityGil Medical Center

With the wide use of esophagogastroduodenoscopy,the incidence of gastric subepithelial tumor(SET)diagnosis has *** the management of large orsymptomatic gastric SETs is obvious,treatment of small(≤3 cm)asymptomatic gastric SETs remains ***,the presence of gastrointestinal stromal tumors with malignant potential is of concern,and endoscopic treatment of gastric SETs remains a subject of ***,numerous studies have demonstrated the feasibility of endoscopic treatment of gastric SETs,and have proposed various endoscopic procedures including endoscopic submucosal dissection,endoscopic muscularis dissection,endoscopic enucleation,endoscopic submucosal tunnel dissection,endoscopic full-thickness resection,and a hybrid approach(the combination of endoscopy and laparoscopy).In this review article,we discuss current endoscopic treatments for gastric SETs as well as the advantages and limitations of this type of ***,we predict the availability of newly developed endoscopic treatments for gastric SETs.

关键词： subepithelial tumor Endoscopy Stomach Treatment Complication

Gastric adenocarcinoma mimicking a submucosal tumor: A case report

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World Journal of Clinical Cases 2019年第19期7卷 3138-3144页

作者： Xiao-Li Cheng Hua Liu Department of Gastroenterology Qingdao Sanatorium of Shandong ProvinceQingdao 266071Shandong ProvinceChina Department of Gastroenterology the Affiliated Hospital of Qingdao UniversityQingdao 266003Shandong ProvinceChina

BACKGROUND Submucosal tumor(SMT)-like early-stage gastric cancer(GC) has rarely been reported. It is difficult to consider the possibility of GC and differentiate it from other submucosal *** SUMMARY We present the case of a 50-year-old male patient with a 1.6 cm SMT-like flat elevated lesion covered by congested mucosa on the gastric angle. Magnifying endoscopy with narrow-band imaging, endoscopic biopsy, endoscopic ultrasound, and computed tomography were performed for *** submucosal dissection and gastrectomy with lymph node dissection were performed. The post-resection pathological analysis led to a final diagnosis of GC(Bormann type Ⅰ, T1bN2M0).CONCLUSION GC should be considered when detecting an SMT-like lesion in the stomach.

关键词： subepithelial lesion Early-stage gastric adenocarcinoma Endoscopic submucosal dissection Case report