Analysis of pathological features and distribution characteristics of 1237 upper gastrointestinal submucosal tumors

Abstract

Objective To explore the pathologic features and distribution characteristics of upper gastrointestinal submucosal tumors (SMT). Methods From January 2013 to December 2017, at Department of Gastroenterology of Taizhou Hospital Affiliated to Wenzhou Medical University, clinical data of 1 182 hospitalized patients with 1 237 upper gastrointestinal SMT who underwent endoscopic therapy and diagnosed by pathology and immunohistochemistry was retrospectively analyzed including the pathological types, tumor of locations, endoscopic findings, layer of origin and tumor size. Results There were 473 esophageal SMT, including 387(81.8%) leiomyomas, located in the mucosal muscularis or muscularis propria; and 59(12.5%) cysts located in the submucosa or mucosal muscularis. There were 138(29.2%) lesions, 159(33.6%) lesions and 176(37.2%) lesions in the upper, middle and lower esophagus respectively, and the most common type was leiomyoma. A total of 723 tumors were gastric SMT, among them 284(39.3%) lesions were gastrointestinal stromal tumors (GIST) and 273(37.8%) lesions were leiomyomas, and all located in the muscularis propria. A total of 69(9.5%) lesions located at cardia, the common types were leiomyoma (55 lesions, 79.7%) and GIST (nine lesions, 13.0%). A total of 239 (33.1%) lesions located at gastric fundus, the common types were GIST (152 lesions, 63.6%) and leiomyoma (79 lesions, 33.1%). A total of 280(38.7%) lesions located at gastric body, the common types were leiomyoma (138 lesions, 49.3%) and GIST (111 lesions, 39.6%). A total of 127(17.6%) lesions located at gastric antrum, the common types were heterotopic pancrease (71 lesions, 55.9%) and lipoma (26 lesions, 20.5%), and all were located in the submucosa, some involved the muscularis propria. There were six (0.8%) lesions at gastric angle, and two (0.3%) at gastrointestinal anastomosis. Forty-one lesions were duodenal SMT, among them 23(56.1%) located at duodenal bulb, the common types were cyst (10 lesions, 43.5%), lipoma (five lesions, 21.7%) and heterotopic pancrease (five lesions, 21.7%). A total of 18(43.9%) lesions located at descending duodenum, the common types were lipoma (nine lesions, 50.0%) and cyst (five lesions, 27.8%), and all lesions located in the submucosa. Conclusions The most common type of SMT in the esophagus and cardia is leiomyoma, however the SMT in gastric fundus and body are mostly leiomyomas and GIST, while in gastric antrum, most SMT are heterotopic pancreases and lipomas. In duodenal bulb and descending duodenum, the common types of SMT are cyst and lipoma. Key words: Leiomyoma; Gastrointestinal stromal tumors; Endosonography; Upper gastrointestinal submucosal tumors; Pathological characteristics; Locations