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Case Reports
. 2020 Dec:24:1-3.
doi: 10.7812/TPP/20.029.

From Dyspepsia to Diagnosis: A Rare Gastric Subepithelial Lesion Definitively Diagnosed via Endoscopic Submucosal Dissection and Immunohistochemistry

Shreyas Srinivas  1 , Sajjad Syed  2 , Sathima Natarajan  2 , Karl Kwok  3
Affiliations
Case Reports

From Dyspepsia to Diagnosis: A Rare Gastric Subepithelial Lesion Definitively Diagnosed via Endoscopic Submucosal Dissection and Immunohistochemistry

Shreyas Srinivas et al. Perm J. 2020 Dec.

Abstract

Introduction: Peripheral nerve sheath tumors, known as perineuriomas, are typically found on the trunk and extremities. They are less commonly described in the gastrointestinal tract (GI), and extremely rarely are described in the stomach.

Case presentation: We present a case of a 2-cm gastric perineurioma in a 42-year-old patient with nonspecific GI complaints of chronic dyspepsia and epigastric discomfort. Esophagogastroduodenoscopy, followed by endoscopic ultrasound, revealed a 2-cm umbilicated lesion in the stomach, which was subsequently removed with endoscopic submucosal dissection and sent for pathology. Immunohistochemical staining revealed a rare entity known as a gastric perineurioma.

Conclusion: Since the first case of gastric perineurioma was first described in 2004, there have only been 4 reported cases in the English literature. This case highlights the crucial interdisciplinary multidisciplinary effort between pathologists and GI specialists required to reach this diagnosis and showcases endoscopic diagnosis using endoscopic dissection, which allows for complete lesion resection and complete resolution of the patient's symptoms.

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Figures

Figure 1.
Figure 1.
EUS image of lesion in the gastric body involving the mucosa and submucosa. 101x101mm (72 x 72 DPI).
Figure 2.
Figure 2.
High magnification image showing a cellular proliferation of spindle cells arranged in short interlacing fascicles with collagenous and loosley myxoid stroma. 97x97mm (300 x 300 DPI).
Figure 3.
Figure 3.
The lesional cells showed expression for NKIC3. 97x97mm (300 x 300 DPI).
Figure 4.
Figure 4.
The lesional cells were positive for GLUT-1. 97x97mm (300 x 300 DPI).
See this image and copyright information in PMC

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References

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