• Case report
• Diagnosis
• Gastric neoplasms
• Neoplasm metastasis
• Small cell lung cancer

• Humans
• Stomach Neoplasms/pathology
• Lung Neoplasms/secondary
• Lung Neoplasms/pathology
• Male
• Small Cell Lung Carcinoma/secondary
• Small Cell Lung Carcinoma/pathology
• Small Cell Lung Carcinoma/diagnostic imaging
• Middle Aged
• Fatal Outcome
• Aged
• Gastroscopy
• Female
• Tomography, X-Ray Computed
• Immunohistochemistry
• Biopsy

• breast cancer
• endoscopy
• esophageal cancer
• gastric tumors
• melanoma
• metastasis
• stomach cancer

• colorectal cancer
• esophagogastroduodenoscopy
• metastatic cancer
• signet-ring cell carcinoma

• adult intussusception
• case report
• renal cell carcinoma
• solitary metastasis
• surgical oncology

Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.

The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.

A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235−0.895; p=0.022).

Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

• Gastrointestinal endoscopy
• Melanoma
• Neoplasm metastasis
• Stomach neoplasms
• Systematic review

Intussusception is a relatively common disease in pediatric age but it is uncommon in adults. We report a case of a 49-year-old male who presented with an acute jejunojejunal intussusception revealed by abdominal pain and vomiting. He underwent an en bloc resection, and pathological findings concluded to a metastasis of a pulmonary combined small cell carcinoma and adenocarcinoma. A subsequent CT scan revealed the primitive mass of the right lung with no evidence of secondary localization. The biopsy was difficult to perform. The patient underwent a pneumonectomy with lymph node dissection confirming the same diagnosis. He made a good recovery from the surgery, and a postoperative chemotherapy was administrated, and he is in remission until this date.

• Gastric metastasis
• case report
• endoscopy
• mucosal erosion
• pancreatic cancer
• pathology

Gastric metastasis of choriocarcinoma is rarely reported in the literature. This case report presents the case of multiple metastatic testicular choriocarcinoma mimicking gastric cancer, with melena as the initial symptom. In this case, ¹⁸fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) showed that the testis was the primary focus. The contribution of PET/CT is significant to primary focus detection in metastatic diseases of unknown primary origin that presented gastrointestinal bleeding. In addition to its use in staging of testicular carcinoma, PET/CT provides significant benefit in evaluating patients with increased levels of tumor markers and in detecting recurrence.

• 18F-FDG PET/CT
• Gastric metastasis
• melena
• testicular choriocarcinoma

• Colorectal cancer
• Gastric metastasis
• Metastatic tumor
• Signet-ring cell carcinoma

Lung cancer is a common malignancy which is frequently found to metastasize to distant sites including bone, liver, and adrenal glands. There are rare reports of metastases to the gastrointestinal (GI) tract, with the duodenum being the most uncommon. We present a rare case of a poorly differentiated lung carcinoma metastasizing to the duodenum. This case enhances the medical literature as it provides additional distinct features to the clinical and histological presentation of metastatic lung carcinoma to the GI tract. A 61-year-old male with a history of poorly differentiated lung carcinoma presented with worsening dizziness, fatigue, and early satiety. He had extensive workup done in the past for hemoptysis including a computerized tomography scan of the chest which showed a new lobulated, apical lesion and hilar lymphadenopathy. He ultimately had a transthoracic fine-needle aspiration (FNA) of the mass and was later diagnosed with poorly differentiated lung carcinoma. On examination, the patient was noted to be pale, tachycardic, and hypotensive. The patient was noted to have an acute drop in his hemoglobin requiring fluid resuscitation, multiple blood transfusions, and evaluation with an esophagogastroduodenoscopy. He was found to have an oozing ulcer in the third portion of the duodenum whose biopsies showed poorly differentiated carcinoma with areas of neuroendocrine differentiation, similar to his lung biopsy results, which was consistent with metastatic lung carcinoma.

• Duodenum
• Esophagogastroduodenoscopy
• Gastrointestinal bleeding
• Immunohistochemistry

• Duodenal cancer
• Metastasis
• Ovarian carcinoma

The present report describes the case of an 81-year-old woman who underwent an emergency explorative laparotomy due to small bowel perforation. Diffuse feculent peritonitis due to perforation of the jejunum was identified. In addition, six distinct tumors of the jejunum in close proximity to the perforation site, as well as two more lesions caudally at the ileum, were identified. A separate stenotic tumor was identified at the sigmoid colon, causing moderate dilatation of the whole intestine. An enterectomy, including the perforation site and the proximal six tumors, was performed, followed by limited enterectomies for the distal two tumors and side-to-side anastomoses of the small intestine. All resected tumors were identified at histology as metastatic from lung carcinoma. Postoperatively, the patient remained in a severe septic condition and succumbed the following day. Metastatic lesions from lung carcinoma in the small bowel wall are a rare finding predisposing to bowel perforation. When an acute condition coexists with multiple intestinal metastases, the mortality rate is high despite prompt surgical intervention.

• carcinoma
• gastrointestinal neoplasms
• lung
• metastasis
• perforation
• small bowel

To image stomach wall blood vessels and tissue, layer-by-layer.

We built up the acoustic resolution photoacoustic microscopy (AR-PAM) system for imaging layered tissues, such as the stomach wall. A tunable dye laser system was coupled to a fiber bundle. The fibers of the bundle were placed in nine directions with an incident angle of 45° around a high-frequency ultrasound transducer attached to the acoustic lens. This structure formed a dark field on the tissue surface under the acoustic lens and the nine light beams from the fibers to be combined near the focal point of the acoustic lens. The sample piece was cut from a part of the porcine stomach into a petri dish. In order to realize photoacoustic depth imaging of tumor, we designed a tumor model based on indocyanine green (ICG) dye. The ICG solution (concentration of 129 μM/mL) was mixed into molten gel, and then a gel mixture of ICG (concentration of 12.9 μM/mL) was injected into the stomach submucosa. The injection quantity was controlled by 0.1 mL to make a small tumor model.

An acoustic resolution photoacoustic microscopy based on fiber illumination was established and an axial resolution of 25 μm and a lateral resolution of 50 μm in its focal zone range of 500 μm has been accomplished. We tuned the laser wavelength to 600 nm. The photoacoustic probe was driven to do B-scan imaging in tissue thickness of 200 μm. The photoacoustic micro-image of mucosa and submucosa of the tissue have been obtained and compared with a pathological photograph of the tissue stained by hematoxylin-eosin staining. We have observed more detailed internal structure of the tissue. We also utilized this photoacoustic microscopy to image blood vessels inside the submucosa. High contrast imaging of the submucosa tumor model was obtained using ICG dye.

This AR-PAM is able to image layer-by-layer construction and some blood vessels under mucosa in the stomach wall without any contrast agents.

• Photoacoustic imaging
• Stomach
• Layered tissue
• Acoustic resolution
• Fiber

• Animals
• Coloring Agents/chemistry
• Disease Models, Animal
• Equipment Design
• Humans
• Image Enhancement/methods
• Indocyanine Green/chemistry
• Lasers, Dye
• Microscopy, Acoustic/instrumentation
• Microscopy, Acoustic/methods
• Microvessels/diagnostic imaging
• Stomach/blood supply
• Stomach/diagnostic imaging
• Stomach Neoplasms/diagnostic imaging
• Sus scrofa

• Breast Neoplasms/pathology
• Carcinoma, Lobular/diagnosis
• Carcinoma, Lobular/secondary
• Diagnosis, Differential
• Duodenal Neoplasms/complications
• Duodenal Neoplasms/diagnosis
• Duodenal Neoplasms/secondary
• Female
• Humans
• Intestinal Obstruction/etiology
• Middle Aged

• imaging study
• late metastasis
• malignant lymphoma
• renal cell carcinoma
• small intestine

• gastric metastases
• immunohistochemistry
• non-small cell lung cancer

• colon
• colonoscopy
• endoscopy
• malignancy
• small bowel
• squamous cell carcinoma

Metastasis to the stomach is rare. The aim of this study was to describe and analyze the clinical outcomes of cancers that metastasized to the stomach.

We reviewed the clinicopathological aspects of patients with gastric metastases from solid organ tumors. Thirty-seven cases were identified, and we evaluated the histology, initial presentation, imaging findings, lesion locations, treatment courses, and overall patient survival.

Endoscopic findings indicated that solitary lesions presented more frequently than multiple lesions and submucosal tumor-like tumors were the most common appearance. Malignant melanoma was the tumor that most frequently metastasized to the stomach. Twelve patients received treatments after the diagnosis of gastric metastasis. The median survival period from the diagnosis of gastric metastasis was 3.0 months (interquartile range, 1.0 to 11.0 months). Patients with solitary lesions and patients who received any treatments survived longer after the diagnosis of metastatic cancer than patients with multiple lesions and patients who did not any receive any treatments.

Proper treatment with careful consideration of the primary tumor characteristics can increase the survival period in patients with tumors that metastasize to the stomach, especially in cases with solitary metastatic lesions in endoscopic findings.

• Endoscopy
• Metastasis
• Stomach

• Lung carcinoma
• Magnifying colonoscopy
• Metastasis
• Pedunculated-type T1 colorectal carcinoma

We report of a patient with metastatic adenocarcinoma of the esophagus and stomach from lung cancer. The patient was a 68-year-old man receiving radiotherapy and chemotherapy for stage IV lung cancer, without metastases to the gastrointestinal (GI) tract at the time of the initial diagnosis. During the treatment period, dysphagia and melena newly developed. Upper GI endoscopy revealed geographic erosion at the distal esophagus and multiple volcano-shaped ulcers on the stomach body. Endoscopic biopsy was performed for each lesion. To determine whether the lesions were primary esophageal and gastric cancer masses or metastases from the lung cancer, histopathological testing including immunohistochemical staining was performed, and metastasis from lung cancer was confirmed. The disease progressed despite chemotherapy, and the patient died 5 months after the diagnosis of lung cancer. This is a case report of metastatic adenocarcinoma in the esophagus and stomach, which are very rare sites of spread for lung cancer.

• Esophageal neoplasms
• Lung neoplasms
• Stomach neoplasms

• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/secondary
• Aged
• Colonic Neoplasms/diagnostic imaging
• Colonic Neoplasms/pathology
• Duodenal Neoplasms/diagnostic imaging
• Duodenal Neoplasms/secondary
• Duodenum
• Fatal Outcome
• Humans
• Lung Neoplasms/diagnostic imaging
• Lung Neoplasms/pathology
• Male
• Middle Aged
• Radiography

• Cholecystitis
• chemotherapy
• cholecystectomy
• colon cancer
• transverse colon

AIM: To discuss the clinical characteristics, diagnosis and treatment of metastatic carcinoma to the stomach from different primary sites.

METHODS: Ten patients diagnosed with metastatic carcinoma to the stomach at our hospital from January 1990 to January 2010 were included in the study. The clinical characteristics, diagnosis, treatment, and prognosis of metastatic carcinoma to stomach from different primary sites were analyzed.

RESULTS: Esophageal cancer was the most common primary tumor. The patients usually had a tumor history, and it was difficult to distinguish between secondary and primary gastric cancer because of their similar clinical manifestations. The diagnosis depended mainly on a tumor history and histopathological examination. The prognosis was poor, and their median survival time was 9.5 months. Early diagnosis and timely operation might improve prognosis.

CONCLUSION: Metastatic carcinoma to the stomach is a kind of extremely rare secondary carcinoma and is difficult to differentiate from primary gastric cancer. The diagnosis is dependent on a tumor history and histopathological examination, and operation should be made a priority for treatment.

• Gastric metastatic carcinoma
• Esophageal cancer
• Melanoma
• Liver cancer
• Lung cancer
• Kidney carcinoma
• Breast carcinoma

Gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma is rare. Metastases to the stomach have been commonly reported with melanoma and with primary tumors of the breast, lung, ovary, liver, colon and testis. We report a patient who presented with epigastric pain and in whom subsequently upper endoscopy showed a malignant gastric ulcer secondary to direct invasion from pancreatic adenocarcinoma of the body. An 81-year-old female presented to our hospital with epigastric pain and subsequently underwent endoscopy with endoscopic ultrasound for evaluation of a pancreatic body mass. She had a large gastric ulcer in the fundus which was in direct continuity with the pancreatic mass. Pathology from biopsy of the ulcer revealed invasive well-to-moderately-differentiated adenocarcinoma, and immunohistochemical stains were strongly positive for CA19-9, CK7, CK19 and carcinoembryonic antigen. These findings were consistent with a histopathological diagnosis of metastatic carcinoma of the pancreas. Patients with gastrointestinal metastases usually have advanced malignancy with poor prognosis. Endoscopic evaluation with adequate biopsies should be performed for symptomatic patients.

• Endoscopic evaluation
• Gastric ulcer
• Gastrointestinal metastasis
• Pancreatic adenocarcinoma

Gastric cancer is one of the most common malignancies in the world and is the second most common cause of cancer-related death in Korea. Colorectal metastases from gastric adenocarcinoma are known to be very rare. We report an unusual case of rectal metastasis of gastric adenocarcinoma.

We report a case of a 43-year-old female patient with gastric cancer who first presented with epigastric pain. The endoscopic and radiologic findings were suggestive of Borrmann type III advanced gastric cancer with linitis plastica. Radical total gastrectomy with D2 lymph node dissection was performed. The pathology report was AJCC TNM Stage II gastric adenocarcinoma (T3N0M0). On follow up at 34 months after surgery, the patient complained of difficulty in defecation. On colonoscopy, a hard, indurated extraluminal mass was detected 7 cm proximal to the anal verge. The biopsy demonstrated chronic nonspecific colitis. Abdominal CT, rectal MRI and PET-CT revealed rectal metastasis from gastric cancer. Laparoscopic ultralow anterior resection with diverting ileostomy was performed. The pathology report was metastatic adenocarcinoma, and this diagnosis was identical to the gastric pathology reported in the previous pathology report. The patient was discharged after the 11^th postoperative day with no adverse events.

Rectal metastasis from gastric cancer is known to be very rare. However, metastatic gastric adenocarcinoma should be considered as a differential diagnosis for patients presenting with a colorectal mass and a past history of gastric cancer.

AIM: To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal (GI)-tract metastases, focusing on therapeutic options and outcomes.

METHODS: Our institution (the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008, of which 21 developed symptomatic GI metastases. This study reviewed all of the patients’ information, including survival data, pathological reports, and surgical notes.

RESULTS: The most common histological type of lung cancer was adenocarcinoma, and 0.26% of patients with lung cancer developed GI metastases. The median duration from lung cancer diagnosis to GI metastases was three months (range, 0-108 mo), and the average time from diagnosis of GI metastasis to death was 2.8 mo. Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy. In contrast, small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy. All patients with small bowel or colonic metastases underwent surgical intervention, and their perioperative mortality was 22%. Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively. In patients with multiple GI metastases, the presentation varied according to the locations of the metastases.

CONCLUSION: Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction. Physicians should be more alert to symptoms or signs indicating GI metastases.

• Gastrointestinal metastasis
• Lung cancer
• Palliative effect
• Prognosis
• Surgical intervention

We present an unusual case of renal cell cancer (RCC) which relapsed with duodenal metastasis and unveiled itself by gastrointestinal (GI) bleeding. An 80-year old Caucasian gentleman with history of renal cell cancer status post nephrectomy 11 mo previously, presented with syncope and melena. Computed tomography scan of the abdomen revealed heterogeneous soft tissue mass in the right nephrectomy bed invading the duodenum. Upper GI endoscopic biopsy confirmed the presence of recurrent renal cell cancer. However, due to extensive metastatic disease, the patient was placed on palliative chemotherapy as surgical options were ruled out. Our case report reiterates the fact that renal cell carcinoma can recur with gastrointestinal manifestations and, although a rarity, it should be considered in a patient with a history of malignancy who presents with these symptoms.

• Duodenal metastasis
• Renal cell cancer
• Upper gastrointestinal bleed

Massive upper gastrointestinal bleeding due to malignancy is relatively uncommon and the duodenum is the least frequently involved site. Duodenal metastasis is rare in renal cell carcinoma (RCC) and early detection, especially in case of a solitary mass, helps in planning further therapy. We report a case of intractable upper gastrointestinal bleeding from metastatic RCC to the duodenum. The patient presented with melena and anemia, 13 years after nephrectomy for RCC. On esophagogastroduodenoscopy, a submucosal mass was noted in the duodenum, biopsies of which revealed metastatic RCC. In conclusion, metastasis from RCC should be considered in nephrectomized patients presenting with gastrointestinal symptoms and a complete evaluation, especially endoscopic examination followed by biopsy, is suggested.

• Duodenum
• Gastrointestinal bleeding
• Metastases
• Pancreaticoduodenectomy
• Renal cell carcinoma

Endoscopic ultrasonography (EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors, due to its higher sensitivity and specificity than other imaging modalities. EUS can characterize lesions by providing information on echogenic origin, size, borders, homogeneity, and the presence of echogenic or anechoic foci. Linear echoendoscopes, and recently also electronic radial echoendoscopes, can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses, and thus permit the differentiation of vascular structures from cysts, as well as the assessment of the tumor blood supply. However, the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers. It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS. On the other hands, EUS guided fine needle aspiration (EUS-FNA) can provide samples for cytologic or histologic analysis. Hypoechoic lesions of the 3rd and the 4th EUS layers, more than in 1 cm diameter are recommended, and histologic confirmation using endoscopic submucosal resection or EUS-FNA should be obtained when possible. Therefore, EUS-FNA plays an important role in the clinical management of subepithelial tumors. Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial tumors.

• Endoscopic ultrasonography
• Submucosal tumor
• Subepithelial tumor

• Gastric metastasis
• Ovarian adenocarcinoma
• Submucosal tumor

• Adult
• Antineoplastic Combined Chemotherapy Protocols/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Biomarkers, Tumor/blood
• Bleomycin/administration & dosage
• Choriocarcinoma/complications
• Choriocarcinoma/diagnosis
• Choriocarcinoma/drug therapy
• Choriocarcinoma/pathology
• Choriocarcinoma/secondary
• Choriocarcinoma/surgery
• Chorionic Gonadotropin/blood
• Chorionic Gonadotropin, beta Subunit, Human/blood
• Cisplatin/administration & dosage
• Combined Modality Therapy
• Etoposide/administration & dosage
• Gastrointestinal Hemorrhage/etiology
• Gastroscopy
• Humans
• Ifosfamide/administration & dosage
• Lung Neoplasms/diagnosis
• Lung Neoplasms/drug therapy
• Lung Neoplasms/secondary
• Lung Neoplasms/surgery
• Male
• Occipital Lobe/pathology
• Occipital Lobe/surgery
• Remission Induction
• Retroperitoneal Neoplasms/complications
• Retroperitoneal Neoplasms/diagnosis
• Retroperitoneal Neoplasms/drug therapy
• Retroperitoneal Neoplasms/pathology
• Retroperitoneal Neoplasms/surgery
• Stomach Neoplasms/complications
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/pathology
• Stomach Neoplasms/secondary
• Stomach Neoplasms/surgery
• Supratentorial Neoplasms/drug therapy
• Supratentorial Neoplasms/secondary
• Supratentorial Neoplasms/surgery
• Thoracic Surgery, Video-Assisted

• Breast neoplasms
• Neoplasm Metastasis
• Stomach neoplasms

• Aged
• Biopsy/methods
• Biopsy, Fine-Needle/methods
• Cohort Studies
• Endosonography
• Female
• Follow-Up Studies
• Humans
• Immunohistochemistry
• Linitis Plastica/diagnostic imaging
• Linitis Plastica/mortality
• Linitis Plastica/pathology
• Linitis Plastica/secondary
• Male
• Middle Aged
• Neoplasm Staging
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/secondary
• Retrospective Studies
• Risk Assessment
• Sensitivity and Specificity
• Survival Analysis
• Video Recording

• Acute Disease
• Algorithms
• Catheter Ablation
• Endoscopy, Gastrointestinal
• Epinephrine/administration & dosage
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/instrumentation
• Humans
• Injections
• Peptic Ulcer/diagnosis
• Peptic Ulcer/etiology
• Postoperative Care
• Vasoconstrictor Agents/administration & dosage

• Adult
• Choriocarcinoma/secondary
• Humans
• Male
• Stomach Neoplasms/secondary
• Testicular Neoplasms/pathology

This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy. The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification. The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts. Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.

• Submucosal tumor
• Immunohistochemistry
• Smooth muscle derived submucosal tumors
• Submucosal tumors of neurogenic origin
• Gastrointestinal stromal tumor
• Malignant
• Benign

• Antigens, CD34/analysis
• Gastric Mucosa/pathology
• Gastrointestinal Neoplasms/classification
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Stromal Tumors/classification
• Gastrointestinal Stromal Tumors/pathology
• Humans
• Intestinal Mucosa/pathology
• Proto-Oncogene Proteins c-kit/analysis

This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However, benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor, imatinib.

• Submucosal tumor
• Treatment
• Case story
• Endoscopic mucosal resection
• Imatinib

• Benzamides
• Endoscopy, Gastrointestinal
• Female
• Gastric Mucosa/pathology
• Gastrointestinal Neoplasms/therapy
• Gastrointestinal Stromal Tumors/therapy
• Humans
• Imatinib Mesylate
• Intestinal Mucosa/pathology
• Middle Aged
• Piperazines/therapeutic use
• Pyrimidines/therapeutic use

This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.

• Submucosal tumor
• Diagnosis
• Endoscopy
• Endoscopic ultrasonography
• Computed tomography
• Magnetic resonance imaging
• Positron emission tomo-graphy
• Capsule endoscopy
• Push-and-pull enteroscopy

• Biopsy, Needle
• Endoscopy, Gastrointestinal
• Endosonography
• Gastric Mucosa/pathology
• Gastrointestinal Neoplasms/diagnosis
• Gastrointestinal Stromal Tumors/diagnosis
• Humans
• Imaging, Three-Dimensional
• Intestinal Mucosa/pathology
• Magnetic Resonance Imaging
• Positron-Emission Tomography
• Tomography, X-Ray Computed