PMC5768268_01
(A, B) Esophagogastroduodenoscopy showing a 6-mm diameter submucosal tumor on the greater curvature of the gastric body with no mucosal change. (C) Endoscopic ultrasound demonstrating a homogeneous, hypoechoic lesion located mainly within the submucosal layer closer to the muscularis propria.
10.1177_1179547617749226-fig1.jpg
PMC5768268_01_10.1177_1179547617749226-fig1.jpg
fig1-1179547617749226
Esophagogastroduodenoscopy (EGD) showed type A chronic atrophic gastritis and small SEL on the greater curvature of the gastric body (Figure 1A and B). The size of the SEL was 6 mm (Figure 1C).
(A) Image of endoscopic ultrasound-guided fine-needle aspiration procedure with a forward-viewing and curved linear-array echoendoscope. A long arrow shows the needle, and a short arrow shows the subepithelial lesion. (B) Microscopic examination revealed small, nearly homogeneous neoplastic cells, with round or oval nuclei and rich cytoplasm (HE, x400). (C) Immunohistologic examination showed that chromogranin A was positive (chromogranin A, x1,000).
10.1177_1179547617749226-fig2.jpg
PMC5768268_01_10.1177_1179547617749226-fig2.jpg
fig2-1179547617749226
Therefore, we performed EUS-FNA using FVCLA-EUS with an attached cap (XGIF-UCT160 J-AL5; Olympus Corp., Tokyo, Japan; Figure 2A). An adequate histologic sample was obtained, and immunohistologic examination showed that chromogranin A was positive (Figure 2B and C).
Laparoscopic and endoscopic cooperative surgery procedure. (A, B) A circumferential incision was made around the tumor by an endoscopic submucosal dissection technique using an insulation-tip knife 2. (C, D) The postexcisional hole in the stomach was sutured under laparoscopic view and clipped endoscopically.
10.1177_1179547617749226-fig3.jpg
PMC5768268_01_10.1177_1179547617749226-fig3.jpg
fig3-1179547617749226
Therefore, we chose to perform a full-thickness, local excision using LECS (Figure 3).
(A, B) The depth of the tumor invasion was into the submucosal layer closer to the muscularis propria: comparison with endoscopic ultrasound findings (HE, x100). (C) Pathologic examination revealed small, nearly homogeneous neoplastic cells with round or oval nuclei and rich cytoplasm (HE, x1,000). (D) Chromogranin A expression was positive in tumor cells (chromogranin A, x1,000). (E) Synaptophysin expression was positive in tumor cells. (F) MIB1-LI 0.8% (5/632) (MIB1-LI, x1,000).
10.1177_1179547617749226-fig4.jpg
PMC5768268_01_10.1177_1179547617749226-fig4.jpg
fig4-1179547617749226
Pathologic examination revealed small, nearly homogeneous neoplastic cells with round or oval nuclei and rich cytoplasm (Figure 4C). Immunostaining for chromogranin (Figure 4D) and synaptophysin (Figure 4E) was positive. The mitotic count was <2% (Figure 4F). The tumor had invaded into a deep layer of submucosa (Figure 4A), but the horizontal and vertical margins were free of tumor cells.