Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa With Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery

Abstract

Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by enterochromaffin-like cells of the stomach. Optimal management of GNETs has not yet been definitively determined. Endoscopic resection is approximately recommended for small GNETs associated with hypergastrinemia. However, endoscopic resection might present risk of perforation or positive vertical margin because neuroendocrine tumors occur in the deep mucosa, with some invading the submucosa. In this case, a patient with type A chronic atrophic gastritis had a small subepithelial lesion in a deep submucosal layer, and we diagnosed it as GNET using endoscopic ultrasound-guided fine-needle aspiration biopsy using a forward-viewing and curved linear-array echoendoscope. Moreover, our results show that laparoscopic and endoscopic cooperative surgery with regional lymph node dissection is a safe and feasible procedure for GNETs, especially those that cross to the muscularis propria. We suggest this approach as one therapeutic option for GNETs because it safely minimizes resection and is less invasive.

Management of Gastrointestinal Neuroendocrine Tumors

“…57 It is recommended to endoscopically assess the GI tract if NET liver metastasis is of unknown origin to identify the primary tumor and rule out concomitant malignancies. 58 Endoscopic ultrasound (EUS) is commonly used for diagnostic biopsy 59 and may have an interventional role in selected cases using adjunct procedures such as radiofrequency ablation. 60 EUS also plays an important role in preoperative staging by assessing tumor size, depth of invasion, and lymph node involvement.…”

“…Endoscopic ultrasound (EUS) is commonly used for diagnostic biopsy 59 and may have an interventional role in selected cases using adjunct procedures such as radiofrequency ablation. 60 EUS also plays an important role in preoperative staging by assessing tumor size, depth of invasion, and lymph node involvement.…”

Combination of laparoscopy and endoscopy as an option for treatment patients with gastric neuroendocrine tumors

“…The volume of removed gastric tissue can be unreasonably enlarged during laparoscopic resections in cases of small gastric NETs. Combination of the gastroscopy and laparoscopy can become an option of choice when each of techniques shows its best aspects [4].…”

“…Combination of laparoscopy and gastroscopy can be an optional approach in treatment of patients with multiple gastric NETs. It helps to avoid large gastric resections an controls the wholeness of gastric wall from abdominal cavity [4].…”

EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?

“…Since NETs can arise from the muscularis mucosa, most times, a forceps biopsy can lead to diagnosis. When the lesion lies completely in the submucosal layer, then an EUS-FNB is necessary [ 15 ]. No data were found in the literature that determine the frequency of NETs lying only in the submucosa.…”