A 36-year-old female patient with no relevant personal history.
In 2004, after presenting symptoms of abdominal pain in epigastrium and dyspepsia, upper endoscopy showed an antral gastric ulcer without signs of complication.
In 2009, the patient came to the emergency room for severe abdominal pain without other symptoms. Computed tomography (CT) showed a contained perforation of the known ulcer.
Conservative management was decided, with good clinical outcome.
Currently he only refers, reason why a control upper digestive endoscopy is performed in which the gastric antrum shows lesser curvature a tumor obstructing the cavity.
Abdominal CT showed an antral-pylorus thickening of the wall of 24.6 mm and a length of 5.6 cm, with an air bubble inside.
Endoscopic ultrasound (Echo-EDA) was performed with needle aspiration (FNA), which showed a 37 mm submucosal lesion at the antrum level.
FNAC reports digestive cells and some spindle cells that could correspond to both gastric muscle layer and benign lesion type leiomyoma vs GIST without atypia or mitosis.
The case is discussed in the tumour committee and given the above background and the possibility that it was a GIST, scheduled surgery was decided.
A laparoscopic subtotal gastrectomy with Roux-en-Y reconstruction was performed.
The patient has a good postoperative evolution, tolerates liquid diet on the third day and is discharged on the sixth postoperative day.
The pathological anatomy describes a piece of subtotal gastrectomy 14 x 6 x 3 cm that, externally and at the opening, does not show macroscopic changes.
Serial sections showed a cystic cavity of 0.8 cm in diameter in the thickness of the gastric wall with mucinous content inside.
Microscopically, gastric mucosa with normal characteristics is observed, and in the thickness of the cystic cavity of its normal gastric mucosa wall with well-defined muscular wall and focus of metaplasia compatible with duplication.
