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254 Dear Editor, A 52-year-old female patient presented to the emergency department with hematemesis, hypotension and tachycardia. She had a history of hypertension and denied other illnesses. The gastroscopy revealed an ulcerated 35 mm subepithelial lesion in the upper gastric corpus. The computed tomography excluded suspicious lymph nodes and metastasis. On endoscopic ultrasound (EUS) (UCT 10-140 AL5; Olympus) the lesion was hypoechoic and heterogeneous with ill-defi ned borders [Figure 1a] and originated in the fourth layer. Incidentally, an isoechoic 5.8 mm Doppler negative nodule was identifi ed in the pancreatic tail [Figure 1b]. Fine needle aspiration was taken with a 22C needle from the gastric lesion and with a 25-gauge needle from the pancreatic nodule. Cell block cytology was consistent with a gastric stromal tumor [Figure 2a-c] and a neuroendocrine pancreatic tumor [Figure 3a and b]. The patient was readmitted 6 days after discharge with recurrent bleeding and hemodynamic instability and underwent an atypical gastrectomy. At 2 years follow-up there is no evidence of gastric stromal tumor recurrence nor pancreatic neuroendocrine tumor size increase or metastasis.

Gastric gastrointestinal stromal tumor and neuroendocrine pancreatic tumor: Always neurofibromatosis?