Electronic Clinical Challenges and Images in GI Unusual Submucosal Tumor in the Stomach

Question: A 35-year-old woman (gravida 4, para 3) was admitted at 19 weeks’ gestation with a 2-week history of constant epigastric pain associated with nausea, vomiting, and an isolated episode of melena. She denied use of nonsteroidal anti-inflammatory drugs. Her past history was unremarkable. On examination, her abdomen was benign and she was hemodynamically stable. Hemoglobin on admission was 7.9 mg/dL. Esophagogastroduodenoscopy demonstrated a 1-cm ulcer (Figure A, arrow) with no stigmata of bleeding overlying a 3-cm area of redundant gastric folds (Figure A, arrowhead). To exclude an underlying mass, linear array ultrasonography (Figure B) was performed revealing a 6 6-cm, inhomogeneous mass with irregular outer borders located in the proximal gastric body and extending to the spleen, left hemidiaphragm, and pancreatic tail. Fine needle aspiration (FNA) was performed. She subsequently underwent an en bloc partial gastrectomy and splenectomy. The gross specimen showing the resected portion of the stomach and the spleen (Figure C) and H&E stained section of the stomach (Figure D) are shown. What is the diagnosis? Seethe GASTROENTEROLOGYwebsite(www.gastrojournal.