Chromoendoscopy-guided biopsies in rare gastric neoplasm

Introduction: Early detection of malignant neoplasms in the gastrointestinal tract is essential to improve patient prognosis and reduce the repetition of tests. However, conventional white light endoscopy has limitations in characterizing flat lesions, and biopsy forceps prove ineffective for subepithelial lesions.

Clinical Case: We present the case of a 28-year-old male with a recent diagnosis of HIV stage C3, requiring intestinal resection due to hemorrhagic shock secondary to diffuse large B cell lymphoma (EBV+). A follow-up positron emission tomography (PET) scan described high metabolic activity in the stomach. Gastroscopy revealed numerous red-wine-coloured flat polypoid lesions with variable diameter, along with secondary thickening of the greater curvature folds in the gastric corpus. Virtual chromoendoscopy showed a preserved and regular crypt pattern, with foveolar edema and loss of the subepithelial capillary network. In the duodenum, mucosal congestion involving a third of the circumference was noted, with areas of ulceration. Biopsies of the gastric lesions were negative for malignancy, while the duodenal biopsies were consistent with Kaposi's sarcoma (KS).

Conclusions: HIV-related Kaposi's sarcoma frequently involves visceral organs, with the gastrointestinal tract being the most common site. Chromoendoscopy provides better characterization of the mucosal pattern, enhancing the diagnostic yield of biopsies. The "biopsy over biopsy" technique should be avoided in high-risk bleeding lesions, prioritizing biopsy of ulcerated areas to improve diagnostic accuracy.

Publication History

Article published online:
27 March 2025