Short Communication: Gastroenterology
We would like to alert the reader to an unusual presentation of splenosis as a gastric subepithelial mass found on endoscopy. We performed an upper endoscopy to evaluate vomiting and dysphagia, in an 18-month-old girl, who was post repair of cleft lip and palate and G-tube dependent. She had no history of splenic trauma or splenectomy. Two distinct fundic masses were found (Fig. 1A) that appeared to be due to extrinsic compression, as their appearance was unchanged with gastric distension. Histology of the overlying mucosa was normal. Abdominal ultrasound revealed a round 3 × 2 cm mass between the stomach and the spleen that was isoechoic with the spleen with similar Doppler flow characteristics compatible with a splenule (Fig. 1B and C).
Splenules and splenosis presenting as gastrointestinal subepithelial masses have been reported in adults. (1–4). They have been mistaken for gastrointestinal stromal tumors (1,3). Patients may present with abdominal discomfort or gastrointestinal bleeding (1,2,4). Classically, patients have a history of a splenectomy or splenic injury, subsequently resulting in hypertrophy of previously undetected splenules or fragment autotransplantation (splenosis) into gastric or intestinal submucosa (1–4).
Generally, gastrointestinal subepithelial masses can be due to intramural lesions or extrinsic compression by intra-abdominal organs, for example, the left lobe of the liver, gallbladder, spleen, colon, or pancreas, or by an abnormal structure such as a pancreatic pseudocyst, renal cysts, enlarged lymph nodes, or an abscess (5,6). Intramural lesions can be benign or malignant. Benign lesions include lipomas, leiomyomas, varices, pancreatic rest, duplication cysts, and inflammatory polyps. Malignant lesions or lesions with malignant potential include gastrointestinal stromal tumors, carcinoid, lymphoma, and metastases (5,6). Overall, subepithelial masses are very rare in children, with the exception of lipomas, pancreatic rest, and duplication cysts.
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mimicking a gastrointestinal stromal tumor
. J Gastrointest Liver Dis
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masquerading as gastric fundic mass
. Am J Gastroenterol
5. Hwang JH, Rulyak SD, Kimmey MB, et al. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology
6. Hwang JH, Saunders MD, Rulyak SJ, et al. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest Endosc