Endoscopic submucosal dissection of gastric plexiform fibromyxoma, an alternative to the traditional approach

We report the case of a 62-year-old female with no his-tory of interest who presented with dyspepsia of 2 years duration. Gastroscopy revealed a subepithelial lesion at the greater antral curvature with an irregular surface and preserved mucosal and vascular pattern, which was 15 mm in diameter. A radial endoscopic ultrasonogram (EUS) was performed due to clinical persistence, which showed a well-delimited hypoechoic lesion with heterogeneous areas that was dependent on the muscularis mucosae lay-er. A biopsy was obtained using the ???bite-on-bite??? tech-nique, which provided no pathological findings. Thus, an endoscopic submucosal dissection (ESD) procedure was performed with wide margins and no complications. Patho-logical analysis found low-grade mesenchymal fusicellu-lar proliferation, dependent on the muscularis mucosae with positive immunohistochemistry for smooth-muscle vimentin and actin, consistent with plexiform fibromyxo-ma (Fig. 1).