Gastric glomus tumor: a case report and review of the literature

Abstract

Introduction: Gastric glomus tumor is a rare mesenchymal neoplasm. There are only a few cases of the tumor showing malignancy, and there are no specific guidelines for the management of this entity.

Case presentation: We present the case of a 53-year-old Caucasian male who was hospitalized for anemia. Computerized tomography of the abdomen depicted a mass between the pylorus of the stomach and the first part of the duodenum. Preoperative diagnosis was achieved with pathology examination of the biopsies taken via endoscopic ultrasound and upper gastrointestinal endoscopy. An antrectomy with Roux-en-Y anastomosis and appendicectomy, due to suspicion of appendiceal mucocele, were performed. The patient had an uneventful postoperative recovery and was discharged 5 days later.

Discussion: Preoperative diagnosis of a gastric glomus tumor is difficult owing to the location of the tumor and the lack of specific clinical and endoscopic characteristics. Furthermore, it is exceptional to establish diagnosis with biopsies taken through endoscopic ultrasound or upper gastrointestinal endoscopy, prior to surgical resection. Although most glomus tumors are benign and are not known to metastasize, there are rare examples of glomus tumors exhibiting malignancy. Treatment of choice is considered wide local excision with negative margins. However, long-term follow-up is required as there is the possibility of malignancy.

Conclusion: The aim of this report is to enlighten doctors about this uncommon pathologic entity. Surgical resection is considered the golden standard therapy to establish a diagnosis and evaluate the malignant potential.

Keywords: Follow-up; Gastric glomus tumor; Preoperative diagnosis; Wide local excision.

Fig. 1

Operative view of gastric glomus tumor

Fig. 2

View after antrectomy

Fig. 3

Multiple cellular neoplastic nodules extending into the muscularis propria, submucosa, and gastric mucosa [hematoxylin and eosin (H&E) ×40]

Fig. 4

Solid proliferation of cells with round uniform nuclei, light eosinophilic or clear cytoplasm, and highly vascularized stroma (H&E ×200)

Fig. 5

A Monotonous cells with well-defined membranes. No mitosis, necrosis, or significant nuclear atypia is observed. Immunohistochemical stains showed diffuse positive cytoplasmic expression of smooth muscle actin (SMA) (B), while CD117 (c-kit) (C) and desmin (D) are negative