Clin Endosc.  2015 Jan;48(1):74-77. 10.5946/ce.2015.48.1.74.

An Extremely Rare Case of Gastric Subepithelial Tumor: Gastric Endometriosis

• Ha JK
• Choi CW
• Kim HW
• Kang DH
• Park SB
• Kim SJ
• Hong JB

• KMID: 2221763
• DOI: http://doi.org/10.5946/ce.2015.48.1.74

Abstract

Endometriosis is a disease characterized by the presence of endometrial tissue outside of the uterine cavity. It is common in women of childbearing age, and is most frequently located in the pelvic cavity. Approximately 10% of endometriosis cases occur outside of the pelvic cavity in locations such as the intestines, genitourinary system, kidneys, lungs, and skin. However, there have been few reports of endometriosis in the stomach. Here, we report a rare case of endometriosis that presented as a subepithelial stomach tumor.

Keyword

Endometriosis; Stomach; Subepithelial tumor

MeSH Terms

Endometriosis*
Female
Humans
Intestines
Kidney
Lung
Skin
Stomach
Urogenital System

Figure

• 

  Fig. 1 An endoscopic finding showing a 2-cm sized subepithelial tumor on the lesser curvature of the antrum. The mucosa of the lesion appears to be normal.

• 

  Fig. 2 (A) Abdominal computed tomography shows a gastric subepithelial tumor on the antrum (black arrow). The subepithelial mass is non-enhanced, well demarcated, and appears to be homogenous and hypodense compared to the gastric mucosa. (B) Endoscopic ultrasonography shows a homogenous hypoechoic lesion within the proper muscle layer. Its echogenicity appears to be more hyperechoic than that of the muscle layer.

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  Fig. 3 Surgical and histologic specimens. (A) A subepithelial tumor is observed in the stomach. (B) Multiple intramural hemorrhagic cysts and hemosiderin-laden macrophages are apparent (H&E stain, ×400).

Reference

1. Fernández Vozmediano JM, Armario Hita JC, Cuevas Santos J. Cutaneous endometriosis. Int J Dermatol. 2010; 49:1410–1412. PMID: 21091675.

2. Kanthimathinathan V, Elakkary E, Bleibel W, Kuwajerwala N, Conjeevaram S, Tootla F. Endometrioma of the large bowel. Dig Dis Sci. 2007; 52:767–769. PMID: 17268828.

3. Clement PB. Diseases of the peritoneum. In : Kurman RJ, editor. Blaustein's Pathology of the Female Genital Tract. 5th ed. New York: Springer-Verlag;2002. p. 761–762.

4. Ridley JH. The Histogenesis of endometriosis: a review of facts and fancies. Obstet Gynecol Surv. 1968; 23:1–35.

5. Rock JA, Markham SM. Pathogenesis of endometriosis. Lancet. 1992; 340:1264–1267. PMID: 1359329.

6. Douglas C, Rotimi O. Extragenital endometriosis: a clinicopathological review of a Glasgow hospital experience with case illustrations. J Obstet Gynaecol. 2004; 24:804–808. PMID: 15763794.

7. Veeraswamy A, Lewis M, Mann A, Kotikela S, Hajhosseini B, Nezhat C. Extragenital endometriosis. Clin Obstet Gynecol. 2010; 53:449–466. PMID: 20436322.

8. Kaufman LC, Smyrk TC, Levy MJ, Enders FT, Oxentenko AS. Symptomatic intestinal endometriosis requiring surgical resection: clinical presentation and preoperative diagnosis. Am J Gastroenterol. 2011; 106:1325–1332. PMID: 21502995.

9. Griffin JB, Betsill WL Jr. Subcutaneous endometriosis diagnosed by fine needle aspiration cytology. Acta Cytol. 1985; 29:584–588. PMID: 3861050.

10. Delpy R, Barthet M, Gasmi M, et al. Value of endorectal ultrasonography for diagnosing rectovaginal septal endometriosis infiltrating the rectum. Endoscopy. 2005; 37:357–361. PMID: 15824947.

11. Pishvaian AC, Ahlawat SK, Garvin D, Haddad NG. Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis. Gastrointest Endosc. 2006; 63:331–335. PMID: 16427951.

12. Chung SK, Lee SH, Son BS, et al. Rectal endometriosis that is difficult to differentiate from endoscopically resectable subepitherial lesion. Korean J Gastrointest Endosc. 2010; 41:319–323.

13. Nishida T, Kawai N, Yamaguchi S, Nishida Y. Submucosal tumors: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors. Dig Endosc. 2013; 25:479–489. PMID: 23902569.

14. Mekky MA, Yamao K, Sawaki A, et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc. 2010; 71:913–919. PMID: 20226456.

15. Kashyap P, Medeiros F, Levy M, Larson M. Unusual submucosal tumor in the stomach. Diagnosis: endometriosis. Gastroenterology. 2011; 140:e7–e8. PMID: 21530527.

16. Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003; 185:596–598. PMID: 12781893.