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

Gastric Perineurioma: A Case Report and Review of the Literature

“…Lastly, Srinivas et al 14 reported the fifth example of gastric perineurioma in a 42-year-old female in 2020. This patient presented with dyspepsia and gastric discomfort for 4 years and was found to have a 2 cm umbilicated mass in the gastric body on esophagogastroduodenoscopy.…”

“…Including these prior patients, 10–14 gastric perineurioma appears to have a predilection for women (5:1) and occurs at an average age of 43.8 years. In three of six patients, 11,13,14 non-specific epigastric pain was the presenting symptom and appeared to be relieved with removal of the lesion. In two patients (current case and Matsui et al 12 ) the perineurioma appears to be of doubtful clinical significance.…”

“…For those cases with follow-up available (ranging from 3 months to 3 years) all patients were without symptoms and alive and well after endoscopic removal and there have been no reports of malignancy or metastases. 11,14…”

“…One of the six patients had a large ulcerated mass causing recurrent upper gastrointestinal bleeding (UGI), 10 while three patients (including the current patient) had polypoid lesions 11,13 Gastric examples tend to occur more commonly in the gastric body or fundus (five of six reported examples). 10,[12][13][14] The average size of the lesions seen endoscopically is 1.14 cm. [10][11][12][13][14] Histologically, all of the tumors demonstrated a bland spindle cell proliferation composed of cells with wavy nuclei with pale eosinophilic to clear cytoplasm indistinct cell borders.…”

“…9 While colonic perineurioma is a relatively common lesion, gastric perineurioma is exceedingly rare with only 5 previously reported cases in the English literature. [10][11][12][13][14] Notable differences in lower gastrointestinal tract perineuriomas versus those seen in the stomach include a common association with serrated polyps (either hyperplastic polyps or sessile serrated lesions), a process typically limited to the lamina propria (versus common involvement of the lamina propria and submucosa in gastric examples), and BRAF V600E mutations in the serrated epithelial lesions (this has not been identified in gastric examples). 1,2,5,[7][8][9][10][11][12][13][14] Herein we report the sixth patient with a gastric perineurioma and review the prior 5 reported patients.…”