Submucosal Tumours

Submucosal tumours are a group of benign tumours that may be met with in the stomach and in the small and large bowel.

In the first picture you see the sight that met us at endoscopy in the stomach of a young man who came with the complaint of repeated bleeding from the stomach. The picture shows an ulcerated submucosal tumour the size of an apple cut across the middle. Because this patient was a panicky one, and because he had been unable to tolerate the endoscopy well on five earlier occasions, no good endoscopic assessment had been made and no diagnosis reached. He was operated on and was rid of the repeated bleeding.

Granular cell tumour. These are submucosal masses that look like a lipoma (a fatty lump), can reach 5–40 mm in size, feel firmer than a lipoma when touched with the biopsy forceps, and can uncommonly turn malignant. They are met with by chance during endoscopy, and the diagnosis is made by examination by the pathologist and by special staining techniques (immunohistochemical stains). They are generally treated by polypectomy (picture 3).

Lipoma means a fatty lump. In some people fat collects locally under the skin and forms lumps that can be felt with the hand. In much the same way, fatty lumps can also form inside the bowel; these too are lipomas. At colonoscopy they form yellow, soft masses under the lining, or polypoid shapes. The diagnosis is made by examining the biopsies taken in the pathology laboratory (pictures 2 and 4).

In picture 5 you see a benign submucosal tumour (arising from the tissue beneath the lining) inside a patient’s stomach, with smooth edges, which can sometimes ulcerate and cause bleeding. Examination by the pathologist showed that it arose from the muscular layer (leiomyoma).