Abstract We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor SET and that was diagnosed by endoscopic ultrasound fine-needle biopsy EUS-FNB. Lesions arising from the muscularis propria usually represent mesenchymal tumors, such as gastrointestinal stromal tumors GIST , leiomyomas and schwannomas[ 1 , 2 ]. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. The patient was completely asymptomatic, without dysphagia or weight loss.
Asymptomatic leiomyomas may be followed up periodically as they have a slow growth rate, and negligible risk of malignant transformation. It has become important to distinguish leiomyoma from other subepithelial masses, which have different prognoses and treatment options. Endoscopic ultrasound EUS is currently recommended as the preferred investigation modality to establish the exact nature of SETs because of its accuracy in differentiating them from extrinsic compression and providing information about morphology and layer of origin[ 2 ]. The diagnosis is challenging because of the low incidence, especially when gastric metastases present as a subepithelial tumor. The diagnosis of SETs can be challenging because conventional endoscopic biopsies are frequently inconclusive. The patient was completely asymptomatic, without dysphagia or weight loss. These findings supported the final diagnosis of a metastatic adenocarcinoma of ovarian origin. Gastric metastasis from ovarian cancer is unusual, either as synchronous with the primary tumor or appearing several years after its initial diagnosis. Leiomyoma presenting as a massive calcified circumferential esophageal mass. Gastric metastasis from ovarian cancer is unusual, presenting synchronously with the primary tumor but also several years later than the initial diagnosis. A diagnosis of circumferential esophageal leiomyoma was made. The immunohistochemistry was positive for desmin Fig. She was referred at that time to our endoscopic center for evaluation of dyspepsia. Herein, we describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric SET mimicking a GIST and diagnosed by EUS-guided tissue acquisition. Published by Baishideng Publishing Group Inc. EUS-FNA has proven to be a safe and effective technique to diagnose these lesions, especially when immunohistochemical analysis is performed. Lesions arising from the muscularis propria usually represent mesenchymal tumors, such as gastrointestinal stromal tumors GIST , leiomyomas and schwannomas[ 1 , 2 ]. A A homogenous hypoechoic well-circumscribed tumor with some calcifications inside, originating from muscle layer and that completely encircles the upper third of the esophagus. Biopsies of the overlying mucosa proved inconclusive. Figure 1 Endoscopic ultrasound findings. All authors made equal contributions to this manuscript. The patient started paclitaxel chemotherapy and was alive at the mo follow-up visit. An upper gastrointestinal endoscopy was unremarkable while an endoscopic ultrasound EUS revealed an homogenous hypoechoic well-circumscribed subepithelial mass with some calcifications inside, originating from the muscle layer and that completely encircled the upper third of the esophagus Fig. Malignant gastric lesions are rarely metastatic and the primary tumor is mainly breast, lung, esophageal cancer or cutaneous melanoma. After explanation of the condition and its long-term implications, the patient refused surgical treatment and is currently asymptomatic, with no change in size of the lesion over the last 2 years.
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