상피하종양은 위내시경 중 우연히 발견되고 특히 위에서 자주 발견된다. 십이지장에서도 발견될 수 있는데, 특히 유두부 주위에 융기된 병변이 관찰되면 총담관이나 췌장과의 관계를 평가해야 하며 상피하종양뿐만 아니라 암이나 자가면역질환도 감별 진단에 고려하여야 한다. 이 증례의 환자는 내시경 검사 중 우연히 유두부 주위에서 상피하종양으로 의심되는 병변이 발견되어 진료 의뢰되었다. 환자는 무증상이었고, 신체 진찰 및 혈액 검사 소견은 정상이었다. 내시경적 조직 검사 결과에는 특이 소견은 없었으나 영상 검사 등을 종합하였을 때 악성 가능성을 완전히 배제할 수 없었다. 따라서 수술로 팽대부 절제술을 시행하였고, 조직 검사 결과 IgG4 연관 팽대부염으로 진단되었다.

Background/Aims: The incidence of duodenal tumors has increased by health surveillance. However, preoperative diagnosis of subepithelial duodenal tumors remains difficult because of the wide variety of pathologies and the location of the tumors. We analyzed endoscopic, radiological, and pathological features of subepithelial benign duodenal tumors (BDTs), which were treated by surgical resection. Methods: Five patients with subepithelial BDTs treated by surgical resection were analyzed retrospectively. We compared the preoperative and postoperative diagnosis and evaluated the clinical presentations, endoscopic and radiological findings, surgical treatments, pathological results, and outcomes of these patients. Results: All the patients underwent successful surgical resection. There were two cases of gastrointestinal stromal tumors (GISTs) treated with segmental duodenectomy, one case of carcinoid tumor treated with antrectomy, one case of gangliocytic paraganglioma treated with ampullectomy, and a lipoma removed by mass excision. The two GISTs were in the duodenal third and fourth segment close to the pancreas, and it was difficult to exclude pancreatic tumors by imaging studies. All the patients remained healthy for more than three years. Conclusions: Subepithelial BDTs are rare and difficult to diagnosis. Awareness and preoperative diagnosis of subepithelial BDTs can lead to minimally invasive treatment, including endoscopic or local surgical resection.

We report on a unique case of diffuse large B-cell lymphoma of the cecum, which presented as a subepithelial tumor. A 62- year-old woman with abdominal pain underwent a colonoscopy, resulting in detection of a subepithelial tumor measuring 2 cm in the cecum. We performed a right hemicolectomy with diagnostic and curative intent; histological examination and immunohistochemical staining of the resected tumor indicated a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete remission with combination chemotherapy.