Endoscopy-assisted laparoscopic wedge-resection of gastric glomus tumor: A case report

Abstract

Introduction: Glomus tumor is a pericytic mesenchymal neoplasm that most commonly occurs in the extremities. The occurrence in visceral organs is rare and is a differential diagnosis with other gastric submucosal tumors.

Presentation of case: A woman with epigastric pain underwent esophagogastroduodenoscopy (EGD) which revealed a gastric submucosal tumor. Endoscopic ultrasound with fine-needle aspiration allowed preoperative diagnosis of gastric glomus tumor. Intraoperative EGD-assisted laparoscopic segmental gastrectomy was successfully performed. The patient was discharged in the second postoperative day. There was no evidence of recurrence at 8 months of follow-up.

Discussion: The stomach is a rare location for the glomus tumor, a neoplasm of the glomus body, which is a perivascular structure with thermoregulatory function. Preoperative diagnosis is challenging, and endoscopic ultrasound (EUS) is useful for both assessing malignancy-associated features and biopsy guiding. The treatment is surgical resection with attention to adequate oncological margins while preserving healthy gastric wall.

Conclusion: Immunohistochemical analysis of specimen obtained by EUS fine-needle allows accurate preoperative diagnosis and laparoscopic-endoscopic combined surgery allows good oncological and functional results.

Keywords: Case report; Endoscopy; Glomus tumor; Laparoscopy; Stomach neoplasm.

Fig. 1

Abdominal CT with a solitary gastric lesion (arrow) and a hypervascular enhancement on arterial phase.

Fig. 2

Gastric submucosal tumor at the fundus-body transition (a) and its relationship with the cardia (b) on esophagogastroduodenoscopy.

Fig. 3

Echographic aspect of gastric submucosal tumor measuring 10.5 mm × 9.8 mm (a) and central anechoic area (b).

Fig. 4

Gastric glomus tumor after wedge resection.