Korean J Gastroenterol.  2018 Dec;72(6):304-307. 10.4166/kjg.2018.72.6.304.

Gastric Tuberculosis Presenting as a Subepithelial Mass: A Rare Cause of Gastrointestinal Bleeding

• Kim TU
• Kim SJ
• Ryu H
• Kim JH
• Jeong HS
• Roh J
• Yeom JA
• Park BS
• Kim DI
• Kim KH

• KMID: 2429947
• DOI: http://doi.org/10.4166/kjg.2018.72.6.304

Abstract

Gastric tuberculosis accounts for approximately 2% of all cases of gastrointestinal tuberculosis. Diagnosis of gastric tuberculosis is challenging because it can present with various clinical, endoscopic, and radiologic features. Tuberculosis manifesting as a gastric subepithelial tumor is exceedingly rare; only several dozen cases have been reported. A 30-year-old male visited emergency room of our hospital with hematemesis and melena. Abdominal CT revealed a 2.5 cm mass in the gastric antrum, and endoscopy revealed a subepithelial mass with a visible vessel at its center on gastric antrum. Primary gastric tuberculosis was diagnosed by surgical wedge resection. We report a rare case of gastric tuberculosis mimicking a subepithelial tumor with acute gastric ulcer bleeding.

Keyword

Tuberculosis; Endoscopy; Subepithelial; Gastrointestinal hemorrhage

MeSH Terms

Adult
Diagnosis
Emergency Service, Hospital
Endoscopy
Gastrointestinal Hemorrhage
Hematemesis
Hemorrhage*
Humans
Male
Melena
Pyloric Antrum
Stomach Ulcer
Tomography, X-Ray Computed
Tuberculosis*
Tuberculosis, Gastrointestinal

Figure

• 

  Fig. 1 (A) Axial contrast-enhanced CT image revealed a relatively well-defined soft tissue mass (arrow) on the anterior wall of antrum and an enlarged lymph node with peripheral rim enhancement and a hypodense center (arrowhead) in the periportal area. (B) Coronal reformatted contrast-enhanced CT scan showing low attenuating masses with thickened walls (arrowheads) in both subphrenic spaces and an exophytic, enhancing mass in gastric antrum (arrow). (C) CT images taken with lung window setting showing airspace consolidation (arrow) in the right lower lobe. CT, computed tomography.

• 

  Fig. 2 Gastroduodenal endoscopy revealed an intraluminal protruding mass lesion with overlying ulceration and a visible vessel in the anterior wall of gastric antrum.

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  Fig. 3 (A) The cut surface of the gross specimen showed a pale white, well-circumscribed mass with ulceration in the stomach antrum. (B) Histopathologic examination demonstrated chronic granulomatous inflammation with caseous necrosis surrounded by inflammatory cells (H&E, ×40).

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