Endoscopic ultrasonography of subepithelial lesions.

1. SUBMUCOSAL LESIONS EUS and EUS-FNA Hakan Senturk, MD Professor of Medicine, Chief of Gastroenterology Division Faculty of Medicine Bezmialem Vakif University

3. Duodenum Esophagus Stomach

4. Esophagus Mide Stomach Stomach

12. 1 Irregular border , , echogenic foci, anechoic areas are in favour of malignancy Etiology EUS -layer EUS –appearance GIST 2,4 Hypoechoic 1 Ectopic pancreas 2, 3, and/or 4 Hypoechoic/mixt Lipoma 3 Hyperechoic Carcinoid 2 and/or 3 Mild hypoechoic, homogenous Cyst 3 Anechoic

27. EUS-FNA results GIST 19 (26%) Leomyoma 17 (23.3%) Esophageal cancer 7 ( 9.6%) Gastric cancer 4 (5.5%) Metastatic M. Melanoma 1 (1.4%) Lung cancer 1 (1.4%) MALT lymphoma 1 (1.4%) Granular cell tumor 1 (1.4%) Hyperplastic polyp 1 (1.4%)

28. EUS preliminary diagnosis Final diagnosis GIST 29 23 Leomyoma 19 22 Esophageal cancer 6 8 Lung cancer 1 1 Gastric cancer 6 6 MALT lymphoma 0 1 Duplication cyst 4 4 Ectopic pancreas 0 2 Lipoma 2 2 Fibroma 2 0 Hyperplastic polyp 1 1 Granular cell tumor 1 1 73 73

29. EUS-FNA diagnosis Final diagnosis GIST 19 21 Leomyoma 17 22 Esophageal cancer 7 8 Lung cancer 1 1 Gastric cancer 4 5 MALT lypmhoma 1 1 Duplication cyst 4 4 Ectopic pancreas 0 2 Hyperplastic polyp 1 1 Granular cell tumor 1 1 Lypmh node 2 Metastasis of M. Melanoma Langerhans c. Histiocytosis Inadequate 12 68 68