A 60-year-old woman was referred to our hospital for further evaluation of a gastric submucosal tumor (SMT) on the lesser curvature in the supra-angular region of the stomach. Blood tests revealed elevation of the serum gastrin level and positive test results for intrinsic factor antibody and antiparietal cell antibody. Gastric endoscopy revealed evidence of mucosal atrophy from the fornix to the lower body of the stomach, but not in the antrum. The diagnosis of gastric SMT with type A gastritis was made. EUS revealed an internally heterogeneous hypoechoic tumor localized mainly in the fourth layer of the stomach. Since EUS-guided fine needle aspiration could not be performed successfully on account of the tumor location, we proposed three management options to the patient : observation with annual endoscopy, tumor biopsy using an ESD device, and surgical resection. She decided on surgical resection, and distal laparoscopic gastrectomy was performed. Histology of the resected specimen revealed an aberrant pancreas, Type 1 of Heirich’s classification and the serum gastrin level recovered to almost within the normal range.
