Differentiation of benign and malignant gastric stromal tumors using endoscopic ultrasonography.

BACKGROUND: Endoscopic ultrasonography (EUS) is a useful modality to show the sonographic features of gastric stromal tumors (GST) which originate from the gastric wall, but it is difficult to distinguish benign from malignant tumors. This study tried to discriminate between them by their EUS patterns. METHODS: EUS patterns were obtained from 52 histologically proved GST. The tumor size, echo patterns and irregular margin were analyzed. RESULTS: Of 52 GST, 11 were leiomyosarcoma and 41 were leiomyoma. The mean sizes of the leiomyoma and leiomyosarcoma were 3.3 +/- 1.1 cm and 7.1 +/- 2.2 cm (p < 0.01). Using a tumor size > or = 5 cm as a criterion for malignancy resulted in a sensitivity of 72.7% and a specificity of 85.4%. A sonolucent area inside the tumor, resulted in a sensitivity and specificity of 81.8% and 80.5%. With an irregular tumor margin, the sensitivity and specificity were 90.9% and 90.2%. A combination of all 3 criteria, resulted in a sensitivity and specificity of 72.7% and 90.2%. For benign tumors, the criteria of tumor < 5 cm, no sonolucent areas and no irregular margin had a sensitivity of 80.5% and a specificity of 100%. CONCLUSION: Tumor size is not a sensitive criterion of malignancy. An irregular margin and sonolucent areas in the tumor have better sensitivity and specificity for the diagnosis of malignant GST. On the contrary, a GST smaller than 5 cm in size with neither a sonolucent area nor an irregular tumor margin strongly suggests a benign lesion.

Endoscopic ultrasonographic classification of gastric aberrant pancreas.

BACKGROUND: Gastric aberrant pancreas (GAP) can be demonstrated by its characteristic patterns on endoscopic ultrasonography (EUS). We tried to classify the EUS figures of GAP to provide a useful EUS pattern for diagnosing this disease. METHODS: Among 68 cases of GAP suspected by EUS, 13 patients who were proven to have GAP by histology from surgical specimens (4 cases), mucosectomy (6 cases), and biopsy (3 cases) were enrolled. EUS was performed under a standard procedure using an Olympus EU-M3 machine with a 7.5/12 MHz inter-changeable transducer. The essential histological finding of GAP is pancreatic tissue in specimens. RESULTS: Among 13 patients with GAP (size from 0.7 to 1.6 cm in diameter), 11 tumors were located in the antrum, and 2 were located at the lower body. All 13 tumors arose from the third layer of the gastric wall with an echogenicity higher than the fourth hypoechoic layer. We classified EUS figures of these 13 GAP into 3 types based on the change of the muscular (fourth) layer below the tumor: Type 1 (6 cases), the fourth layer is intact and has a normal thickness; Type 2 (4 cases), the fourth layer has thickened; and Type 3 (3 cases), the fourth layer has thickened, and there are some hyperechoic densities (tubular-like structures) within the fourth layer. Mucosectomy was performed without any complication in 6 cases (four type 1 and two type 2). CONCLUSION: EUS figures of our 13 cases of GAP were classified into 3 types which will be helpful in the EUS diagnosis of GAP and can provide information on selecting patients for mucosectomy.

Demonstration of gastric submucosal lesions by high-resolution transabdominal sonography.

PURPOSE: We evaluated the accuracy of high-resolution transabdominal sonography (TAUS) in identifying and characterizing gastric submucosal masses previously detected by endoscopy. METHODS: Patients given endoscopy for suspected submucosal gastric lesions and 2 patients with gastric wall cysts were enrolled. Patients underwent TAUS and then endoscopic sonography (EUS) on the same day, and the sonographic results were compared with endoscopic and histologic findings. RESULTS: Among 101 patients with gastric submucosal masses on endoscopy, TAUS revealed a mass in 94 (93%); of these 94 patients, 60 underwent EUS. The final diagnoses were 31 leiomyomas, 10 leiomyosarcomas, 13 ectopic pancreases, 2 cysts, and 1 glomus tumor, 1 carcinoid tumor, 1 lipoma, and 1 fibroma. Leiomyomas (mean size, 3.2 cm) and leiomyosarcomas (mean size, 7.1 cm) were shown sonographically to originate from the muscular layer. Ectopic pancreases (mean size, 1.2 cm) were shown to originate from the submucosal layer and had a homogeneously echogenic pattern. Gastric cysts were found in the submucosal layer and were anechoic. The glomus tumor and the carcinoid tumor were found in the muscular layer and were hypoechoic. The lipoma and the fibroma were located in the submucosal layer and were echogenic on TAUS. CONCLUSIONS: TAUS had a detection rate of 93% in visualizing submucosal gastric masses previously identified by endoscopy. TAUS is less invasive than EUS and can be used to follow submucosal gastric masses that are not excised.

Hemorrhagic gastric glomus tumor mimicks a leiomyosarcoma on both transabdominal and endoscopic ultrasonography: case report.

Glomus tumor is a benign tumor that arises from the modified smooth muscle cells of the glomus body and usually occurs in the skin, particularly in the nail-beds and fingertips. Gastric glomus tumor is a rare gastric submucosal tumor. Endoscopic ultrasonography (EUS) is useful in differentiating the gastric submucosal tumors, such as leiomyoma, leiomyosarcoma, lipoma, ectopic pancreas and glomus tumor. On sonography, gastric glomus tumor appears as a homogeneous hypoechoic or a heterogeneous low echoic pattern mixed with internal high echoic spots. Here, we describe an unusual sonographic figure of a hemorrhagic gastric glomus tumor on both EUS and high-resolution transabdominal ultrasonography (TAU). This tumor was located in the gastric muscular layer. Sonographic examination revealed a heterogeneous echogenicity with hyper- and anechoic areas, which mimicked the echoic pattern of gastric leiomyosarcoma.

Rebleeding rate of various stigmata of recent hemorrhage in peptic ulcer bleeding with different severity.

The stigmata of recent hemorrhage (SRH) have been used as a factor for predicting peptic ulcer rebleeding. In previous studies, the rebleeding rate of the visible vessel varied. A hypothesis had been proposed stating that the evolution of the color of the stigmata depends on the point in the healing process of the blood clot on the bleeding ulcer. This retrospective study evaluates the rebleeding rates associated with various colors of stigmata of recent hemorrhage. Of a total of 623 cases of peptic ulcer bleeding (474 male and 149 female, with a mean age of 59 years old), there were 232 gastric ulcers, 369 duodenal ulcers, and 22 stomal ulcers. Stigmata of recent hemorrhage were found in 387 cases (62%). The overall rebleeding rate for those with gastric ulcers was higher than for those with duodenal ulcers (24.2% versus 16.3%, p<0.05), especially for oozing and sentinel clots, the rebleeding rates for active bleeding, blood clots, sentinel clots, and others were 35%, 24.8%, 17%, and 11.3% respectively. The red clot of stigmata of recent hemorrhage had a slightly higher rebleeding rate than the black clot, but the difference was not statistically important. Furthermore, the 5 duodenal ulcers with white sentinel clots experienced no rebleeding. When comparing the rebleeding rates between groups with massive and minor bleeding, a significantly higher rebleeding rate was found in the massive bleeding group (50.5% versus 6.6%, p < 0.001). It can thus be seen that the different types of stigmata of recent hemorrhage represent different stages in the healing process of a bleeding ulcer. A white sentinel clot had a change of not rebleeding.(ABSTRACT TRUNCATED AT 250 WORDS)