Gastric submucosal mass lesions

Abstract

Purpose of reviewGastric submucosal mass lesions are a collection of tumours that arise in the stomach and are deep to the mucosal layer. Distinct from gastric epithelial carcinomas, these tumours are generally more indolent. They are often found incidentally on upper endoscopy. Most often they present as smooth protuberant masses covered by normal intact gastric mucosa. The majority are asymptomatic. Endoscopic ultrasound (EUS) is frequently employed to further characterize the lesions. EUS can be diagnostic of some lesions, such as lipomas, and can be used to guide fine needle aspiration to diagnose others. Adding to the traditional management approaches of observation and surgical resection, numerous new and emerging endoscopic therapies are now being used to resect these gastric tumours.Recent findingsThis review focuses on evolving strategies in the diagnosis and management of submucosal mass lesions. Although surgical intervention was once the lone option for intervention, there are an increasing number of endoscopic therapies. There have also been advancements in neoadjuvant therapies and in distinguishing the malignant potential of submucosal mass lesions.SummaryGastric submucosal lesions are common. EUS is frequently indicated in the evaluation and diagnosis. For tumours for which observation is not recommended, novel endoscopic therapies may offer less invasive management options.

Well-Differentiated Adenocarcinoma Spreading Widely in the Gastric Submucosa

“…In routine clinical practice, we judge a gastric lesion as a cancer when the malignant lesion is surrounded by normal gastric mucosa and as a submucosal gastric tumor when covered with normal gastric mucosa [ 8 ]. Submucosal tumors, however, sometime lack the overlying normal gastric mucosa when they grow too large to disrupt the overlying normal mucosa.…”