Gastric Submucosal Tumor

A 60-year-old woman with a history of iron deficiency anemia was hospitalized because of an episode of melena. A colonoscopy performed a year earlier had shown left-sided diverticulosis but was otherwise unremarkable.

The patient underwent an esophagogastroduodenoscopy, which revealed a submucosal gastric tumor in the antrum, at a distance of 3 cm from the pylorus, in the greater curvature of the stomach. The mucosa covering the mass did not differ from the remaining antral mucosa. Probing of the submucosal tumor with the tip of the biopsy forceps revealed a solid consistency. There was no "cushion sign" suggestive of a soft lesion, such as a cyst or a lipoma.

Histologic examination of biopsy specimens revealed adenocarcinoma, which was most consistent with metastatic colon cancer. Colonoscopy showed left-sided diverticulosis and a right-sided colon cancer.

Luca C. Fry, MD, and Klaus E. Mnkemller, MD, of Magdeburg, Germany, write that the most common malignancy in the stomach is primary gastric cancer that arises from the glands of the mucosa.¹ The stomach can be involved in the metastasis of other cancers, such as malignant melanoma (the most frequently observed) and cancer of the breast, colon, lung, ovary, liver, and testis. Symptoms of metastatic cancer are similar to those of the primary cancer (ie, nausea, vomiting, anemia, loss of weight).

Most metastatic cancers present as ulcerated masses or nodules. The presentation of metastatic colon cancer as a submucosal gastric tumor, as in this patient, is unusual.

Histopathologic diagnosis of submucosal GI tumors is usually difficult because they are covered by normal mucosa, and routine surface biopsy is not sufficient to establish the diagnosis. In this case, biopsy specimens were obtained by using a "biopsy-on-biopsy" technique.²

A submucosal tumor of the intestinal tract also can be explored with endoscopic ultrasonography. However, endoscopic ultrasound-guided fine-needle aspiration has relatively low sensitivity for cytopathologic diagnosis.³

This patient underwent right hemicolectomy and received chemotherapy. An esophagogastroduodenoscopy performed 6 months later showed no recurrence of the gastric lesion.

References:

REFERENCES:1. Davis GR. Neoplasms of the stomach. In: Sleisenger M, Fordtran J, eds. Gastrointestinal Disease. Vol 1. 5th ed. Philadelphia: WB Saunders Co; 1993:763-789.
2. Karita M, Tada M. Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy. Gastrointest Endosc. 1994;40:749-753.
3. Rösch T. Endoscopic ultrasonography in upper gastrointestinal submucosal tumors: a literature review. Gastrointest Endosc Clin N Am. 1995;5:609-614.