A Case of Parasitic Eosinophilic Granuloma of the Stomach Presenting with Upper Gastrointestinal Bleeding

Park, In Suh; Chon, Chae Yoon; Lee, Kwan Sik; Park, Hyo Jin; Chung, Jun Pyo; Kim, Ho Guen; Cho, Hyeon Geun; Seo, Jung Kun; Kim, Ki Whang; Sohn, Seung Kook

Abstract

The localized eosinophilic granulomatous lesions of the stomach are rare benign tumorous conditions resembling submucosal tumors. They can be divided into two types. One is an inflammatory fibroid polyp. The other is an eosinophilic granuloma due to migration of Anisakis-type larva in the alimentary tract. The latter is usually found in the gastric body and anterior wall of the angle, and appears as a submucosal tumor. Histologically, the granuloma exhibits a characteristic lamellated structure consisting of a necrotic center with or without the worm, surrounded by layers of granulation tissue and eosinophilic infiltration. The present case is a 50 year-old male presenting with an episode of profuse melena. An emergency esophagogastroduodenoscopy revealed a 2x1.5cm sized, irregularly shaped ulcerative lesion with elevated margins and prominent folds convergence. Despite the endoscopic injection of hypertonic saline-epinephrine solution due to a recent bleeding stigmata, the patient experienced a rebleeding during hospitalization, The locally excised specimen showed an eosinophilic granuloma having a central necrosis. Although the larval body of Anisakis was not found, the lesion was diagnosed as a parasitic eosinophilic granuloma of the stomach.