Laparoscopic antral resection with Billroth I reconstruction for a gastric glomus tumor

Abstract

Introduction: Gastric glomus tumors are fairly uncommon and mostly benign, with an estimated incidence of 1% of all GI soft tissue tumors. The most common GI site of involvement is the stomach, and in particular the antrum. Some cases have been discovered incidentally, but most are symptomatic presenting with GI bleeding, perforation or abdominal pain. Glomus tumors are submucosal tumors and hence mistaken with the more frequent gastrointestinal stromal tumors.

Presentation of case: A 33-year-old woman presented with intermittent dull upper abdominal pain for two days. Abdominal computed tomography (CT) was performed showing a hyperdense mass in the antrum. Endoscopy and endoscopic ultrasound revealed a submucosal antral mass along the greater curvature, suspicious for a gastrointestinal (GI) stromal tumor (GIST), a laparoscopic antrectomy with Billroth I reconstruction was done. Pathological examination revealed that the mass was a gastric glomus tumor.

Discussion: The presented case report met all the usual standard criteria commonly used to identify glomus tumors, the uniqueness of the case lies in the occurrence of the glomus tumor in the stomach, first suspected as GIST, then confirmed as a gastric glomus tumor. The vast majority of glomus tumors of the GI tract have been described in the gastric antrum. They occur in adults of all ages with a significant female predominance (78%).

Conclusion: This case may aid in improving the recognition and diagnosis of this rare entity and in differentiating it from more common GISTs and gastric carcinoids. A built up knowledge between physicians is extremely necessary to avoid common confusion in taking the right medical approach.

Keywords: Antrum; Diagnosis; Glomus Tumor; Laparoscopy.

Fig. 1

CT scan of the abdomen and pelvis with IV contrast showing 2.5 cm × 2 cm hyperdense gastric lesion suggesting intramural tumor. (A) Axial cuts (B) coronal cuts.

Fig. 2

(A) Round submucosal lesion noted at the pylorus. (B) Endoscopic ultrasonogrophy (EUS) shows1.7 cm × 2.5 cm slightly hyperechoic round lesion arising from the muscularis propria.

Fig. 3

Laparoscopic resection of the tumor at the antrum using staples, hand sewn anastomsis with Billroth I reconstuction.

Fig. 4

Gross pathology of the tumor showing intramural lesion.

Fig. 5

Trabeculae of tumor cells distributed next to the stomach's muscularis propria (Hematoxylin and Eosin stain 100×).

Fig. 6

Glomus tumor of the stomach (smooth muscle actin (SMA) stain that is strongly positive in glomus cells and in the smooth muscle of the muscularis propria 100×).