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Image of the Month—Diagnosis
Arch Surg. 2007;142(9):900.
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Answer: Gastrointestinal Stromal Tumor of the Ampulla of Vater
The endoscopic picture (Figure 1) depicted a bulging ampulla of Vater with an essentially normal overlying mucosa except for hyperemia. At EUS (Figure 2), the mucosa (first layer, hypoechoic) appeared uniform and normal and a localized tumor mass was seen originating from the deeper layers. This ruled out an ampullary carcinoma as well as other periampullary and pancreatic head carcinomas or neuroendocrine tumors.
Figure appears in full text version.
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Figure 1. Polypoid lesion at the ampulla of Vater.
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Figure 2. Endosonography showing a hypoechoic lesion.
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The differential diagnosis in this patient was therefore between tumors arising from the submucosa (neural tumors, lymphoma, or lipoma) and those arising either from the muscularis mucosa or propria (gastrointestinal stromal tumor [GIST], leiomyomas, or leiomyosarcoma). At EUS, the tumor was hypoechoic and originated from the muscularis propria (the fourth layer, which is hypoechoic). The tumors arising from the submucosa (which is hyperechoic) were thus ruled out. . . . [Full Text of this Article]
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Dinesh Singhal, Mandhir Kumar, Randhir Sud, and Adarsh Chaudhary
Arch Surg. 2007;142(9):899.
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