Editor: Ian Penman
4. Submucosal lesions of the gastrointestinal tract
Raquel E. Davila & Douglas O. Faigel
Fig. 1 (A) Endoscopic view of a 'submucosal' lesion in the gastric fundus with normal-looking overlying mucosa. (B) Radial EUS demonstrates the lesion as homogeneous,
hypoechoic, and arising from the fourth layer (arrowhead, muscularis propria). These features are consistent with a GIST.
Fig. 2 Malignant duodenal GIST. The lesion (G) arises from the fourth layer (muscularis propria) but has an invasive, irregular outer
Fig. 3 This GIST has a heterogeneous appearance and cystic spaces (arrowhead), a feature which may predict malignant behaviour.
Fig. 4 An ovoid, subcentimeter hypoechoic lesion (L) arising from the fourth layer of the esophageal wall is characteristic of a
Fig. 5 (A) Endoscopic view of a smooth submucosal bulge in the gastric antrum. (B) At EUS the lesion is hyperechoic and arises from
the third wall layer (submucosa). These features are characteristic of a lipoma.
Fig. 6 Duodenal carcinoid tumor. (A) endoscopic appearance. (B) EUS reveals a hypoechoic, round lesion arising from the second and
third wall layers. After EMR, histology confirmed a carcinoid tumor.
Fig. 7 Ectopic pancreas. (A) endoscopic viewnote the central depression. (B) At EUS, the lesion (P) is heterogeneous and arises from the second and third layers.
Fig. 8 EUS in a patient with a 'submucosal' bulge in the gastric fundus reveals the abnormality to be the result of extrinsic compression by an accessory spleen or splenunculus
Fig. 9 (A) Endoscopically there is a possible submucosal bulge on the anterior esophageal wall. (B) At EUS the cause is seen to be
an enlarged, reactive-looking subcarinal lymph node (LN).
Fig. 10 At EUS gastric and perigastric varices are seen as anechoic, tubular, or serpiginous structures (V).
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