Résumé
Les tumeurs sous-épithéliales du tractus gastro-intestinal sont rares. Elles constituent cependant, un réel défi en matière de prise en charge, notamment chez les patients asymptomatiques chez qui la lésion est découverte de façon fortuite lors d’une fibroscopie haute effectuée pour une toute autre raison ou pour un symptôme sans lien direct avec la lésion [1].
Lorsque la masse a été identifiée, le premier problème consiste à réaliser un diagnostic différentiel avec une compression extraluminale qui peut être normale ou de nature pathologique dans la mesure où l’endoscopie haute ne permet pas à elle seule de préciser la nature de la structure sous-jacente. La seconde étape consiste à établir les caractéristiques morphologiques de la tumeur en essayant d’évaluer sa nature (en effet, la muqueuse étant indemne, les biopsies endoscopiques sont généralement peu contributives) et à exclure une lésion cystique qui demande généralement une approche conservatrice. Enfin, une décision quant à la prise en charge (chirurgie ou surveillance) doit être prise. Nous allons essayer de répondre à ces questions et surtout discuter de l’intérêt de disposer d’un échantillon de la tumeur en terme d’impact sur la prise de décision et le pronostic. Quoiqu’il en soit, l’indication de l’EUS FNA doit être considérée dans chaque cas, en fonction de l’état clinique du patient, des caractéristiques morphologiques de la tumeur et de l’impact des résultats sur la prise en charge thérapeutique.
Comme la majorité de ces tumeurs sous épithéliales du tractus GI (excepté au niveau de l’œsophage, de lamuscularis mucosae du colon et du rectum, ainsi que d’autres tumeurs plus rares) sont des tumeurs stromales gastro-intestinales (GISTs), nous aborderons ici uniquement ces tumeurs.
Summary
Subepithelial tumors of the gastrointestinal tract are uncommon. However, they often represent a managing challenge, mainly in asymptomatic patients in whom the lesion is found incidentally while the upper endoscopy is performed for any other reason or symptom not related to the tumor. This situation occurs in about 0.5 % of routine endoscopies [1].
The first problem once identified the bulge is the differential diagnosis with an extraluminal compression due to normal or pathological structures since its underlying nature cannot be elucidated by upper endoscopy alone. The second goal is to assess the morphological characteristics of the tumor attempting to ascertain its nature (since endoscopic biopsies are usually inconclusive due to the indemnity of the mucosa) and to exclude cystic lesions that usually require a conservative approach. Finally, a decision on management (surgery or surveillance) has to be taken.
This review is aimed at answering these questions and, mainly, to discuss the usefulness of obtaining a sample of the tumor in terms of impact on decision making and prognosis. However, the indication of EUS FNA in subepithelial tumors has probably to be taken in every single patient depending on the clinical situation, morphological characteristics of the tumor and impact of results on management. Since the majority of subepithelial tumors of the GI tract (except those in the esophagus and muscularis mucosae of the colon and rectum and other more uncommon GISTs, data of this review will mainly refer to them.
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Ginès, A., Fernàndez-Esparrach, G., Pellisé, M. et al. Indications de la ponction-biopsie à l’aiguille fine guidée sous écho-endoscopie (EUS FNA) dans les tumeurs sous-épithéliales. Acta Endosc 35, 1–9 (2005). https://doi.org/10.1007/BF03002640
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DOI: https://doi.org/10.1007/BF03002640