Imaging findings of gastric plexiform fibromyxoma with a cystic change: A case report and review of literature

Abstract

Rationale: Plexiform fibromyxoma (PF) is an extremely rare mesenchymal tumor of the stomach, and its radiological findings have not been well described. Here, we analyzed the imaging features of a case of PF. To our knowledge, this is a rare reported case with a remarkable cystic change in the imaging literature.

Patient concerns: A previously healthy 50-year-old woman presented with a 1-day history of abdominal pain. Then, she underwent computed tomography (CT) and magnetic resonance imaging (MRI). A cystic-solid well-circumscribed extraluminal mass was located in the posterior wall of the gastric upper body. The solid portion appeared as heterogeneous attenuation/intensity with progressive enhancement while the cystic region had no enhancement.

Diagnoses: The potential for malignancy could not be excluded.

Interventions: Laparoscopic partial gastric resection was performed.

Outcomes: Based on pathological findings, a diagnosis of PF was made. The patient was alive without any recurrence or metastasis of the tumor after 2 years of follow-up.

Lessons: As far as we know, a gastric PF with a remarkable cystic change has never been reported. Additionally, the tumor exhibited a progressive enhancement pattern which is a characteristic radiographic feature in our case. Our report may help increase the awareness of this rare but important new disease entity.

Figure 1

A 50-year-old woman with gastric plexiform fibromyxoma. A, D, G, Unenhanced CT scan showed an irregular mass (arrow) of heterogeneous hypoattenuation with the muscle that was located in the posterior wall of the gastric upper body. B, E, Contrast-enhanced CT scan revealed the solid portion (arrow) of the tumor displayed peripheral contrast enhancement in the arterial phase. C, F, The solid portion (arrow) displayed inhomogeneously gradual enhancement in the portal venous phase. H, I, The cystic region (arrow) had no enhancement. CT = computed tomography.

Figure 2

MRI revealed a large exophytic cystic-solid tumor (arrow) that developed from the upper body of the stomach. A1, A2 (A1, T1-weighted imaging; A2, T2-weighted imaging): the solid portion (arrow) of the tumor typically showed iso-intensity on the T1-weighted images and high intensity on the T2-weighted images. B1, B2 (B1, T1-weighted imaging; B2, T2-weighted imaging): the cystic region (arrow) displayed low and markedly high intensity on the T1-weighted and T2-weighted sequences, respectively. A3, B3 (diffusion-weighted magnetic resonance imaging): imaging techniques showed a hyperintense mass (arrow) in the stomach. A4, B4 (apparent diffusion coefficient map): the cystic-solid tumor had hyperintense presentation on ADC map. A5, A6, Contrast-enhanced T1-weighted imaging (A5 arterial phase; A6 delayed phase) demonstrated the solid portion (arrow) with heterogeneously gradual enhancement. B5, B6, Contrast-enhanced T1-weighted imaging (B5 arterial phase; B6 delayed phase) showed the cystic region (arrow) with no enhancement.

Figure 3

A, The gastroscopy showed a submucous eminent lesion (arrow) in the posterior wall of the gastric upper body. B, C, A heterogeneously hypoechoic lesion (arrow) was found at the greater curvature side of the upper body. The irregularly submucosal tumor (arrow) originated from the muscularis propria.

Figure 4

Pathological findings. A–C, Microscopic examination showed that the tumor extended from the muscularis propria to the serosa of the stomach and exhibited a multinodular plexiform growth pattern. These nodules consisted of bland-looking spindle cells admixed with abundant myxoid or fibromyxoid stroma rich in capillary-sized vessels.