Massive Chronic Expanding Hematoma Following EUS-guided Biopsy of a Small Gastric Plexiform Fibromyxoma Mimicking a Gastrointestinal Stromal Tumor.
Plexiform fibromyxoma (PF) is a rare benign mesenchymal tumor of the stomach that can be difficult to distinguish from gastrointestinal stromal tumor (GIST) due to overlapping clinical and imaging features. The risk of hemorrhagic complications following biopsy in PF has not been well established.
A 76-year-old man was followed for a small gastric submucosal lesion that showed gradual enlargement over time. Endoscopic ultrasound (EUS)-guided biopsy was performed to obtain a definitive diagnosis, and the initial histopathological diagnosis suggested GIST. Although the patient remained asymptomatic, magnetic resonance imaging performed two months after biopsy revealed cystic enlargement of the lesion. The lesion subsequently enlarged rapidly, forming a 15-cm cystic mass associated with abdominal pain. EUS-guided drainage was performed; however, progressive anemia developed, requiring repeated blood transfusions. Surgical resection was ultimately performed. Histopathological examination revealed PF, and the cystic lesion was diagnosed as a chronic expanding hematoma, likely caused by biopsy-related capsular injury.
PF can mimic GIST and may lead to severe delayed hemorrhagic complications following biopsy. Careful consideration should be given to invasive diagnostic procedures for gastric submucosal lesions, even when lesions are small and asymptomatic.
A 76-year-old man was followed for a small gastric submucosal lesion that showed gradual enlargement over time. Endoscopic ultrasound (EUS)-guided biopsy was performed to obtain a definitive diagnosis, and the initial histopathological diagnosis suggested GIST. Although the patient remained asymptomatic, magnetic resonance imaging performed two months after biopsy revealed cystic enlargement of the lesion. The lesion subsequently enlarged rapidly, forming a 15-cm cystic mass associated with abdominal pain. EUS-guided drainage was performed; however, progressive anemia developed, requiring repeated blood transfusions. Surgical resection was ultimately performed. Histopathological examination revealed PF, and the cystic lesion was diagnosed as a chronic expanding hematoma, likely caused by biopsy-related capsular injury.
PF can mimic GIST and may lead to severe delayed hemorrhagic complications following biopsy. Careful consideration should be given to invasive diagnostic procedures for gastric submucosal lesions, even when lesions are small and asymptomatic.
Authors
Takematsu Takematsu, Masuda Masuda, Nagayama Nagayama, Kajiwara Kajiwara, Takekuma Takekuma, Motohara Motohara, Komohara Komohara, Adachi Adachi, Oda Oda, Yusa Yusa, Ishiko Ishiko, Beppu Beppu
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