Abstract
OBJECTIVE: Gastrointestinal stromal tumors (GISTs) lack specific clinical manifestations and are challenging to distinguish from other gastric submucosal tumors (SMTs). This study is aimed at illustrating the atypical manifestations of non-GISTs mimicking gastric GISTs and determining whether objective preoperative factors can help differentiate gastric GISTs from non-GISTs in patients. METHODS: We included 29 GIST patients and 27 patients preoperatively misdiagnosed with GIST located in the stomach. We compared demographic data and tumor characteristics based on endoscopic ultrasound (EUS) and computed tomography (CT) findings between GIST and non-GIST groups. RESULTS: Clinical symptoms in the extragastric compressions group were significantly more common (100%) than in the GISTs group (35.7%) (p < 0.05). Gastrointestinal stromal tumors more commonly exhibited an exophytic growth pattern than gastric non-GISTs SMTs (p < 0.05). Mean arterial phase attenuation was significantly lower in gastric non-GISTs SMTs (54.3 HU) compared with GISTs (59 HU, p = 0.003), with an optimal cutoff value of < 28.9 HU and an AUC of 0.689. There was a significant difference in lesion size between the GIST and gastric non-GIST groups, with GISTs presenting larger lesions (4.2 vs. 3.3 cm, p = 0.038). Additionally, necrosis was more frequently observed in the GISTs. CONCLUSIONS: For gastric submucosal protuberant lesions, a comprehensive EUS and CT imaging examination is necessary for accurate diagnosis to avoid misdiagnosis and inappropriate treatment, which may affect patient prognosis.