Duodenal subepithelial hyperechoic lesions of the third layer: Not always a lipoma

Figure 4 Endoscopic, endoscopic ultrasonography and pathological findings of gangliocytic paraganglioma. A: Slightly hyperechoic lesion of the third layer of the duodenal wall; B-E: Endoscopic ultrasonography-fine needle aspiration with cytological features suggestive of GIST; B: Few fragments of loose mesenchymal spindle cell tissue fragments (Papanicolaou staining × 100); C: Cell block preparation of aspirated material, discrete nuclear atypia [Hematoxylin and eosin (HE) × 100]; D: Most cells stain positive for CD117 (× 400); E: Rare cells stained with CD34 (× 400); F: Resection of the subepithelial lesion using endoloop; G-I: Histopathological analysis of the resected tumor; G: Duodenal gangliocytic paraganglioma (HE × 25); H: Duodenal gangliocytic paraganglioma (HE × 200); I: Sustentacular S-100 positive cells documented (S100 ×100). GIST: Gastrointestinal stromal tumor.