Clinical Presentation

A 40-year-old man presents for an upper gastrointestinal barium study to evaluate chronic, mild midepigastric pain.

(A) Double-contrast barium study shows a submucosal lesion (arrow) in the gastric antrum, slightly in profile and slightly en face. A small collection of barium is seen within the center of the lesion. (B) Tangential view of the lesion (arrow) shows it to be focal and submucosal. (C) Single-contrast view en face shows the ovoid lesion with a central contrast collection (arrow).

Differential Diagnosis

• Ectopic pancreatic rest: This is the most likely diagnosis. It is a classic non-neoplastic cause of a single bull’s-eye lesion.

• Spindle cell or stromal tumor: These tumors can be singular, submucosal, and centrally necrotic/ulcerated, including leiomyoma and gastrointestinal stromal tumor (GIST). These neoplasms are typically larger on presentation.

• Primary malignancy: These may be small, solitary, and ulcerated, such as adenocarcinoma, lymphoma, or carcinoid.