PMC6243324_01
A nodular, contrast-enhancing gastric tumour, about 4 cm in diameter, is seen on the CT scan (arrow).
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fig1
As part of the evaluation, a contrast-enhanced CT scan of the abdomen was performed (slice thickness 4 mm, 90 ml Accupaque 350 mg J ml-1, scan delay 70 s post injection), which showed a calcified fibroid of about 5 cm diameter, few slightly enlarged pelvic lymph nodes and a nodular contrast-enhancing tumour within the gastric wall, about 4 cm at its largest diameter (Figure 1).
Endoscopic view of the submucosal gastric tumour during forceps biopsy.
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fig2
Subsequently, gastroscopy demonstrated a bulging submucosal tumour in the fundal area (Figure 2).
On unenhanced CT scan, the gastric tumour is barely delineated from the surrounding structures and seems to be inaccessible for biopsy through the anterior abdominal wall.
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fig3
However, the gastric lumen was partially collapsed and the tumour was barely distinguishable from secretions inside the gastric lumen (Figure 3).
Expansion of the gastric lumen by having the patient swallow effervescent granules with small amounts of water improved delineation of the gastric tumour.
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fig4
Following this, another unenhanced CT scan (Figure 4) was obtained that showed the gastric lumen was now slightly expanded and the tumour was accessible through a transgastric route from the epigastrium.
First, the tip of a 17 G puncture needle (length 17 cm) was pushed through the anterior gastric wall, heading to the tumour (a). Next, the 18 G biopsy needle was inserted and the biopsy chamber was exposed within the tumour (right, white arrow). Subsequently, a spring-loaded mechanism released the outer hull of the biopsy needle to cut off a specimen from the tumour and capture the biopsy sample within the needle sheath (b).
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fig5
The inner stylet of the puncture needle was then removed and a semiautomatic 18 G cutting biopsy needle (20 cm long, Somatex, Teltow, Germany) was inserted. The position of the exposed 20 mm biopsy chamber of the sharp metal stylet within the tumour was confirmed (Figure 5) just before the core biopsy sample was obtained.