Characterization of subepithelial lesions of the stomach and esophagus by contrast-enhanced EUS: A retrospective study

Abstract

Background and Objectives: Subepithelial lesions (SELs) of the upper part of the digestive tract are rare, and it can be difficult to characterize them. Recently, contrast-enhanced endosonography (EUS) and elastometry have been reported as useful adjuncts to EUS and EUS-guided fine needle aspiration (EUS-FNA) in cases of pancreatic mass and lymph node involvement. The aim of this retrospective analysis was to evaluate whether contrast-enhanced EUS can discriminate benign submucosal lesions from malignant ones. We describe our retrospective experience using the contrast agent SonoVue ® (Bracco Imaging, Milan, Italy) in an attempt to increase the diagnostic yield. Patients and Methods: Between May 2011 and September 2014, 14 patients (5 men, 9 women; median age 64 years, range 31–80 years) with SELs of the stomach or esophagus underwent EUS with SonoVue ® (low mechanical index). There were 3 esophageal lesions and 11 gastric lesions. Mean size of the lesions was 30 mm (range 11–50 mm). They were discovered after anemia ( n = 5), dysphagia ( n = 1), and pain ( n = 4) and during follow-up for resected gastrointestinal stromal tumors (GISTs) ( n = 1) and a standard upper gastrointestinal endoscopy ( n = 3). On endoscopic sonograms, 10 of these lesions were hypoechoic and located in the fourth layer (muscularis), and 4 were in the second or third layer (mucosa and submucosa). Contrast enhancement was assessed in the early phase (after several seconds) and late phase (>30 seconds); a final diagnosis was made based on the findings of EUS-FNA using a 19-gauge ProCore (Cook Medical, Bloomington, IN) ( n = 9) or 22-gauge FNA system (Cook Medical) ( n = 1), the resected specimen ( n = 3), or deep biopsy ( n = 1). Different immunostaining was used in the pathologic studies (RNA was analyzed later using the C-kit, CD-117, CD-34, desmin, DOG-1, α-smooth actin, caldesmon, PS-100, and Ki-67 antibodies). Results: Final diagnoses were leiomyoma ( n = 4), GIST ( n = 5), schwannoma ( n = 1), inflammatory tumor of Helvig ( n = 1), pancreas rest ( n = 2), and fibrosis ( n = 1). No complications occurred. All 5 GISTs showed enhancement in the early and late phases, whereas the 8 remaining lesions did not show any enhancement. Only 1 leiomyoma showed heterogeneous enhancement. Limitations: The monocentric and retrospective study design and small number of patients. Conclusions: In cases of SELs of the stomach or esophagus, SonoVue ® ...

Direct endoscopic full-thickness resection for submucosal tumors with an intraluminal growth pattern originating from the muscularis propria layer in the gastric fundus

“…Gastric SMTs can be exactly diagnosed by EUS [6,7]. Considering the malignant potential of some SMTs, especially when the tumor size is more than 20 mm, resection is recommened for the lesion.…”

Schwannoma de Esôfago: Relato de Caso / Schwannoma of the Esophagus: A Case Report

“…O schwannoma possui positividade, dentre os marcadores imunohistoquímicos, para proteína S-100 e GFAP e negatividade para CD117 e SMA (HUNG et al, 2008;CHEN et al, 2006). O papel da quimioterapia e radioterapia, como tratamento adjuvante, por sua vez, permanece indefinido, sendo o tratamento de escolha restrito a ressecção cirúrgica oncológica (HUNG et al, 2008;MORO et al, 2017;TRINDADE et al, 2018). Não há consenso, quanto ao seguimento clínico, sendo que alguns serviços de renome optam por reavaliação semestral (IWATA et al, 2018).…”

Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors

“…It is difficult to distinguish GIST from benign submucosal lesions on fundamental B-mode EUS images. There have been some reports that CH-EUS is useful in distinguishing GIST from benign SET, [8][9][10][11][12] as GISTs had hyper-enhancement Fig. 1.…”

“…5,6 However, it is reportedly difficult to differentiate small GISTs from leiomyomas because of a difference in the shape, echogenicity, and homogeneity of EUS. 7 It was reported that contrast-enhanced harmonic (CH) imaging of EUS was useful in distinguishing GIST from benign SET; [8][9][10][11][12] 10% to 30% of GISTs have a malignant clinical course. Therefore, it is necessary to estimate the malignancy potential of GIST by examining the pattern of microvasculature.…”

“…Therefore, it is necessary to estimate the malignancy potential of GIST by examining the pattern of microvasculature. 10,[13][14][15] Contrast-enhanced ultrasound (US) has recently been found to be useful in the evaluation of treatment response by assessing blood flow in the tumors. 16,17 In this article, we review the principle of CH imaging, provide examples of CH imaging of GIST and benign SET, and describe the prediction of GIST malignancy potential and the evaluation of treatment response in GIST.…”