183 ABCD Arq Bras Cir Dig Letter to the Editor 2011;24(2): 183-185 SPLENOSIS MIMICKING GASTRIC GIST: CASE REPORT AND LITERATURE REVIEW Esplenose mimetizando gist: relato de caso e revisão da literatura Cláudio BRESCIANI, Nélio Reis FERREIRA, Rodrigo Oliva PEREZ, Carlos Eduardo JACOB, Bruno ZILBERSTEIN, Ivan CECCONELLO From Department of Gastroenterology, University of São Paulo, São Paulo, SP, Brazil. Correspondence: Cláudio Bresciani, e-mail: cbresciani@ig.com.br Source of funding: none Confict of interest: none Received: 30/03/2010 Accepted for publication: 25/01/2011 ABCDDV/788 INTRODUCTION Splenosis is the “seeding” or auto transplantation of splenic tissue following splenic trauma or surgery 4 . There is implantation of splenic tissue in the form of encapsulated nodules most often in the peritoneal cavity, but it can also occur in the pleural cavity, pericardium, lung, abdominal wall, subcutaneous tissue and in the brain. In the abdomen, it is usually discovered incidentally as an asymptomatic mass. Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract 14 , and the stomach is the most common primary site. Symptoms include bleeding, pain, discomfort or an abdominal mass with no symptoms. Surgical resection is the preferred treatment option for resectable GISTs, particularly localized primary tumors 5 . Since most GISTs are submucosal, a defnitive pathological diagnosis often cannot be made before surgery. Is reported a case of a gastric submucosal lesion that was initially suspected for gastric stromal tumor by upper gastrointestinal endoscopy and endoscopic ultrasonography (EUS), and splenosis was fnally diagnosed after computed tomography (CT) scan and a Tc-99m labeled heat-denatured red blood cell scintigraphy. To our knowledge, there are no reported cases of splenosis mimicking a gastric GIST. CASE REPORT A 74-year-old male patient was admitted for elective treatment of a gastric submucosal lesion found at upper gastrointestinal endoscopy (Figure 1). He complained of vague upper abdominal pain. Endoscopic ultrassonography revealed a homogeneous bilobular lesion, located in the proper muscle layer of the gastric fundus, measuring 36x25mm and 20x21mm (Figure 2). Since there were large vessels above the lesion, and a high probability of being a GIST warranting surgical resection. A fne- needle aspiration biopsy was not performed. The patient’s past surgical history was notable in that he had undergone a left colectomy for colorectal cancer 20 years earlier. He also underwent a second operation one year after due to a resectable local recurrence, on which occasion his spleen was also removed. He had no history of weight loss nor any intestinal symptoms or signs. His physical examination revealed only a large abdominal incisional hernia. Laboratory work-up was unremarkable. Since the submucosal lesion was highly FIGURE 1 - Endoscopy showing an elevated 3 cm bilobular submucosal lesion located in the gastric fundus, covered with normal mucosa FIGURE 2 - Endoscopic ultrasonography (EUS) showing a hypoechoic bilobular lesion located in the proper muscle layer of the gastric fundus, suggesting GIST. The color Doppler vascular analysis color shows the presence of large vessels above the tumor ABCD Arq Bras Cir Dig 2011;24(2):183-185