Management of gastric glomus tumor: A case report

Abstract

Rationale: Gastric glomus tumor (GGT) is a rare gastrointestinal tumor and its preoperative imaging features are significant to make a correct diagnosis, while the assessment of the pathological and immunohistochemical characteristics of the specimen are the main methods used for its diagnosis. This study introduces the clinical uniqueness, endoscopic ultrasonography, radiology, histology and immunohistochemistry results of a patient with GGT to discuss the imaging and clinico-pathological features, diagnosis and differential diagnosis of GGT.

Patient concerns: The patient expressed a complaint concerning an "intermittent abdominal pain for 4 months".

Diagnoses: The patient was diagnosed with gastric stromal tumor according to the clinical manifestations and imaging examination before the operation. The pathological examination of an intra-operative frozen sample confirmed the benign nature of the tumor, while post-operative immunohistochemistry results indicate the presence of a GGT. The postoperative histology revealed a tumor tissue composed of irregular blood vessels and glomus cells of same size with interstitial hyaline and mucoid degeneration. Immunohistochemical staining showed positivity for SMA (+), vimentin (3+), CD 34 (vascular +), and Factor VIII (vascular +).

Interventions: The tumor was completely removed by surgery.

Outcomes: The patient recovered well, and was discharged from the hospital. Five months after the operation, a normal gastric mucosa was observed by gastroscopic examination.

Lessons: Most of the GGTs are benign lesions, surgical resection is the preferred treatment and they result in a good prognosis. However, malignant GGT should be treated as soon as possible because of its metastatic potential and recurrence. Adjuvant radiotherapy or chemotherapy might be useful after operation.

Figure 1

Endoscopic ultrasonography in the diagnosis of gastric stromal tumors.

Figure 2

Soft tissue shadow (protruding inward) was confined in the gastric antrum with smooth edges, visible punctate calcifications and with its wide base connected to the inner layer of the gastric antrum (gastric wall). MDCT arterial phase of the tumor was significantly enhanced. The serosal surface was smooth and intact. There was no significant lymph node enlargement around the stomach.

Figure 3

A partial resection of the distal stomach was examined, showing a mobile, spherical mass of approximately 2× 2 cm, from the medial to the serosal layer in the gastric antrum. No swollen lymph nodes were observed around the stomach. The frozen specimens showed that the tumor was confined in the mucosa with a greater curvature in the gastric antrum (hematoxylin and eosin staining; 100× magnification).

Figure 4

Tumor tissue consisting of irregular hyperplastic blood vessels and same sized glomus cells, with interstitial hyaline and mucoid degeneration (hematoxylin and eosin staining; A, 200× magnification; B, 100× magnification).