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- Title
AN UNEXPECTED CASE OF GASTRIC SUBMUCOSAL LESION - THE ROLE OF ENDOSCOPIC ULTRASONOGRAPHY.
- Authors
Chriac, Stefan; Sfarti, Catalin; Stanciu, Carol; Trifan, Anca
- Abstract
Introduction. Gastric duplication cysts (GDCs) are rare congenital anomalies that are characterized by the presence of cystic structures within the gastric wall. The diagnostic is challenging as these lesions often present clinical as well as radiological findings common with other gastric lesions. In this report, we present a case of GDC in a young patient presenting for recurrent epigastric pain. Case presentation. A 25-year-old woman presented for recurrent epigastric pain. An upper digestive endoscopy was performed showing a 2 cm submucosal lesion located in the body of the stomach. Subsequently, an endoscopic ultrasound was performed, thus a well-defined cystic lesion was identified. The lesion presented all layers of the gastric wall; therefore, a gastric duplication cyst was suspected. Fine needle aspiration (FNA) was considered but refused by the patient. For further characterization of the lesion, a magnetic resonance investigation (MRI) of the abdomen was carried out. The result confirmed the presence of a lobulate cyst of 18 mm diameter without apparent communication with the gastric lumen. Surgical treatment was discussed with the patient but follow-up was agreed upon. Discussion. GDCs are rare entities, as only 2-8% of digestive tract duplications are found in the stomach. Although they can be symptomatic, most often these lesions are found during examinations performed for other indications. EUS is essential for the characterization of gastric submucosal lesions as it allows the differentiation between cystic and noncystic lesions and it indicates the layer of origin of the lesion. Moreover, FNA can be performed thus aiding in the final diagnostic. In our case, the combination between EUS and MRI played a crucial role in the diagnosis and management of the GDC. EUS allowed the rapid characterization of the lesion and MRI offered detailed anatomical information as well as the relation to adjacent structures without the need for ionizing radiation. Although most patients receive surgical or endoscopic treatment, follow-up is possible, especially in the setting of small GDCs. Conclusion. This case underlines the importance of EUS and MRI in the evaluation of gastric submucosal tumors and for the identification of rare lesions such as GDCs. Both techniques present good accuracy in the characterization of these lesions and allow for a timely diagnosis, preventing the need for more invasive procedures and allowing for subsequent management decisions to be taken.
- Subjects
ENDOSCOPIC ultrasonography; NEEDLE biopsy; MAGNETIC resonance; IONIZING radiation; ALIMENTARY canal; DUODENAL tumors
- Publication
Journal of Gastrointestinal & Liver Diseases, 2023, Vol 32, p69
- ISSN
1841-8724
- Publication type
Article