Toothpick Ingestion Causing Gastric Submucosal Mass and Abscess

A 69 year-old man presented with generalized abdominal pain. As part of the workup, an upper endoscopy was performed, which revealed a submucosal mass in the distal body of the stomach along the greater curvature (Figure 1). Endoscopic ultrasound demonstrated a hypoechoic, heterogeneous, and calcified oval submucosal mass with undefined borders, which appeared to originate from the muscularis propria (Figure 2). The lesion was 20 mm in diameter. The endosonographic features were not typical for a gastrointestinal (GI) stromal tumor. Fine-needle aspiration of the mass was performed with one pass using a 22-gauge needle, which was negative for malignant cells and was otherwise nonspecific. Abdominal computed tomography was then performed and showed a 2.9 x 3.5-cm soft tissue mass arising from the greater curvature of the body of the stomach containing an elongated density possibly representing a calcification; however, a foreign body embedded in the wall causing a foreign body granuloma could not be excluded. The patient underwent a distal gastrectomy with a Billroth II reconstruction to resect the mass. Pathologic evaluation revealed acute and chronic abscess around a wooden stick and actinomycosis overgrowth within the cavity of the mass (Figures 3 and and4).4). Immunostains for CD-117, discovered on GIST 1 (DOG1), S100, smooth muscle actin (SMA), and CD-34 were negative