Incidental gastrointestinal subepithelial mass is increasing with national cancer screening endoscopy. Most of gastrointestinal subepithelial mass are small-sized and asymptomatic tumor with benign nature, but gastrointestinal stromal tumor should be ruled-out because of its malignant behavior. Although conventional endoscopy alone can differentiate the nature of subepithelial mass, more accurate diagnosis can be achieved with endoscopic ultrasonography and its guided biopsy. In this review, differential diagnosis and treatment strategy of incidental gastrointestinal subepithelial mass would be presented.
Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Gastrointestinal Stromal Tumors/*diagnosis/pathology/ultrasonography ; Humans ; Intestinal Neoplasms/diagnosis/pathology/ultrasonography ; Stomach Neoplasms/diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. METHODS: We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. RESULTS: The mean age was 48.9 years old and male to female ratio was 2.6:1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). CONCLUSIONS: Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.
Adult ; Aged ; Esophageal Neoplasms/*pathology/*surgery/ultrasonography ; Esophagus/pathology ; Female ; Gastrointestinal Stromal Tumors/diagnosis/surgery ; Humans ; Intestinal Mucosa/*pathology ; Leiomyoma/diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

Mucosa-associated lymphoid tissue (MALT) lymphoma is a typical primary gastrointestinal lymphoma, particularly in the stomach. Although primary rectal lymphoma is rare, it may present as a subepithelial tumor. Several techniques have been proposed for a tissue diagnosis in subepithelial tumor, including endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA), EUS-guided trucut biopsy (EUS-TCB), and tacked biopsy. However the diagnostic efficacy of these techniques appears to be limited. The unroofing technique involves removal of the overlying mucosa, thereby exposing the subepithelial lesion. It was originally reported as a method for endoscopic treatment of colorectal lymphangioma. In this case, a subepithelial tumor of the rectum was diagnosed using the endoscopic unroofing technique. This is a useful modality for the diagnosis of subepithelial tumor, because it provides histologic results in a safe and rapid manner.
Adult ; Antigens, CD20/metabolism ; Colonoscopy ; Humans ; Immunohistochemistry ; Intestinal Mucosa/surgery ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/ultrasonography ; Male ; Rectal Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography Scanners, X-Ray Computed