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1
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Sandrasegaran K, Shah A, Thompson C, Chen L, Silva A. Imaging findings of gastric glomus tumors. Abdom Radiol (NY) 2025; 50:1099-1104. [PMID: 39276189 DOI: 10.1007/s00261-024-04549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/21/2024] [Accepted: 08/25/2024] [Indexed: 09/16/2024]
Abstract
Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0 cm vs. 5.3 cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5 cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy.
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2
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Peng S, Yang N, Xu Z, Su G, Tuo X, Liu S, Lei Z, Pan G. Malignant glomus tumor of jejunum with liver and peritoneum metastasis: a rare case report. Front Oncol 2025; 14:1519968. [PMID: 39896188 PMCID: PMC11782956 DOI: 10.3389/fonc.2024.1519968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 12/26/2024] [Indexed: 02/04/2025] Open
Abstract
Glomus tumors (GTs) are rare mesenchymal neoplasms that occur predominantly on the subungual region of the distal extremities and are rarely seen in visceral organs such as the gastrointestinal tract. Malignant glomus tumors (MGTs) is even more rare, comprising less than 1% of all GTs. We reported an 82-year-old female patient with MGTs of the jejunum, accompanied by metastases to the liver and peritoneum. The patient presented with a primary complaint of epigastric pain with nausea and acid reflux for two months. Computed tomography scan revealed a prominently enhanced, inhomogeneous-density mass in the jejunum, the nature of which-benign or malignant-could not initially be determined. Postoperative pathological diagnosis confirmed the lesion to be a jejunal MGT. Regrettably, the patient declined additional treatment, subsequently developing liver and peritoneal metastases one year later. She eventually died within 18 months of initial diagnosis. This report summarizes the clinical and histopathological features of jejunal MGTs with the aim of increasing awareness among clinicians and pathologists regarding this disease.
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Affiliation(s)
- Shilan Peng
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Nan Yang
- College of The First Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Zifan Xu
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guomiao Su
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyu Tuo
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shiyue Liu
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zi Lei
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guoqing Pan
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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3
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Fejes R, Gyorgyev KS, Góg C, Krenács L, Zombori T, Széll ZE, Balajthy Z, Pancsa T, Simonka Z. Gastric glomus tumor with uncertain malignant potential: case report of a rare cause of upper gastrointestinal bleeding. World J Surg Oncol 2024; 22:299. [PMID: 39533374 PMCID: PMC11558975 DOI: 10.1186/s12957-024-03563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Glomus tumors (GTs) are mesenchymal neoplasms that are typically benign. Gastric GTs are uncommon and occur mainly in the upper gastrointestinal tract. Malignant gastric GTs are extremely rare, constituting less than 1% of gastric tumors. Because their features are similar to those of other tumors found in the same gastrointestinal region, such as stromal tumors, leiomyomas, lymphomas, and lipomas, the diagnosis is challenging. CASE PRESENTATION A 52-year-old male patient presented with fatigue and melena. The initial endoscopic examination did not locate any source of bleeding. Six months later, pan-gastroscopy, performed due to progressive microcytic anemia, revealed a 40 × 30 mm polypoid lesion with deep ulcerations; histopathological analysis confirmed that it was a gastric GT with expression of alpha-actin and cadherin 17 and a Ki-67 index of 20%. The patient delayed surgical therapy until his symptoms worsened. Laparoscopic sleeve resection revealed a 65 × 45 × 25 mm tumor, and secondary immunohistochemical analysis revealed extensive spread into the mucosa and subserosa. Focally, the tumor bulged into some large veins. Genetic examination with RNA isolation further supported the histopathological diagnosis of gastric GT with uncertain malignant potential. CONCLUSIONS This case underscores the diagnostic challenges posed by gastric GTs because they are rare and their clinical features are similar to those of other gastric tumors. Thorough histopathological and molecular analysis is essential for an accurate diagnosis. Surgical intervention remains the primary therapeutic approach. This case also emphasizes the need for long-term follow-up due to the potential for recurrence and malignancy.
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Affiliation(s)
- Roland Fejes
- Institute for Surgical Research, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary.
- Department of Internal Medicine, Hódmezővásárhely-Makó Healthcare Center, Makó, Hungary.
| | - Kitti Szonja Gyorgyev
- Department of Internal Medicine, Hódmezővásárhely-Makó Healthcare Center, Makó, Hungary
| | - Csaba Góg
- Department of Internal Medicine, Hódmezővásárhely-Makó Healthcare Center, Makó, Hungary
| | - László Krenács
- Laboratory of Tumor Pathology and Molecular Diagnostics, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zsófia Eszter Széll
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Zsófia Balajthy
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Pancsa
- Bioptical Laboratory Ltd, Pilsen, Czech Republic
| | - Zsolt Simonka
- Department of Surgery, Albert Szent-Györgyi Health Center, University of Szeged, Semmelweis Street 8, Szeged, H-6725, Hungary.
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4
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Zironda A, Grotz TE, Folpe AL, Thiels CA. Gastrointestinal Glomus Tumors: A Single Institution, 20-Year Retrospective Study. J Surg Res 2023; 283:982-991. [PMID: 36915027 DOI: 10.1016/j.jss.2022.10.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in particular the stomach, where they have been the subject of case reports and small series. We present our institutional experience with gastrointestinal glomus tumors. METHODS A retrospective review of all gastrointestinal glomus tumors was conducted across all three Mayo Clinic sites in Minnesota, Arizona, and Florida from 2001 to 2021. Patient characteristics, pathologic findings, imaging features, operative reports, and clinical outcomes were abstracted. Descriptive statistics were utilized to report outcomes. RESULTS Nine patients with glomus tumors were identified (five men and four women). The median age was 53 [interquartile range (IQR), 44-69] y. Four patients presented with abdominal discomfort, three had anemia or bleeding, and two tumors were incidentally diagnosed. Computed tomography scans identified masses thought to represent gastrointestinal stromal tumors or neuroendocrine tumors in all patients. The tumors were localized to the stomach in all cases, specifically in the gastric antrum. Seven patients underwent preoperative endoscopy, including five with endoscopic ultrasonography. Endoscopic biopsies were interpreted as glomus tumors (n = 3), neuroendocrine tumors (n = 2), and nondiagnostic (n = 2). All patients underwent open (n = 3) or minimally invasive (n = 6) margin-negative resection by wedge resection (n = 5) or distal gastrectomy (n = 4). No nodal metastases were identified radiographically or on pathologic examination. The median tumor size was 2.5 [IQR 1.3-3.4] cm. All tumors showed at least in part typical glomus tumor morphology and smooth muscle actin expression. Aberrant synaptophysin expression was present in the two tumors initially classified as NET. Using the current WHO criteria, tumors were classified as histologically malignant (n = 1) and of "uncertain malignant potential" (n = 8). At a median follow-up of 15 [IQR 1-56] mo, all patients were asymptomatic and without recurrence. Two patients died of unrelated causes. No patients received adjuvant therapies. CONCLUSIONS Our 20-year, single institution, 3-site experience with resected gastrointestinal glomus tumors suggests the rarity, predisposition to involve the gastric antrum, and potentially an indolent clinical behavior of many of these tumors. Long-term follow-up is warranted as some previously reported gastric glomus tumors have metastasized, including cases lacking morphologic evidence of malignancy. Surgical resection, with minimally invasive wedge resection alone, is likely sufficient for the management of most gastric glomus tumors.
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Affiliation(s)
- Andrea Zironda
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Travis E Grotz
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Bai B, Mao CS, Li Z, Kuang SL. Endoscopic ultrasonography diagnosis of gastric glomus tumors. World J Clin Cases 2021; 9:10126-10133. [PMID: 34904082 PMCID: PMC8638066 DOI: 10.12998/wjcc.v9.i33.10126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/12/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A gastric glomus tumor is relatively rare, and there is little knowledge on its endoscopic ultrasound findings.
AIM To assess the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of gastric glomus tumor and to discuss its value by reviewing the literature.
METHODS A retrospective analysis of the EUS characteristics of gastric glomus tumor (such as tumor location, shape, size, echogenicity, homogeneity, margins, layer of origin, and so on) was performed. The study included 12 cases of gastric glomus tumor confirmed by surgery and pathology (7 females and 5 males, age range 36-74 years, average age was 58.2 years).
RESULTS All the lesions were located in the gastric antrum (12 cases), protruding into the cavity, with a diameter between 1 and 3.5 cm. Glomus tumor of the stomach manifested as a circumscribed and slightly hypoechoic mass in the fourth layer, with an internal heterogeneous echo mixed with hyperechogenic spots and a marginal more hypoechoic halo. Smooth muscle actin, h-caldesmon and vimentin were shown to be positive by immunohistochemistry.
CONCLUSION Although glomus tumor of the stomach is relatively rare, a typical glomus tumor of the stomach has characteristic changes under EUS.
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Affiliation(s)
- Bing Bai
- Oncology Center, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou 450003, Henan Province, China
| | - Chong-Shan Mao
- Public Health Medical Center, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou 450003, Henan Province, China
| | - Zhen Li
- Oncology Center, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou 450003, Henan Province, China
| | - Sheng-Li Kuang
- Department of Digestive Disease, Henan Provincial People's Hospital, Zhengzhou 450003, Henan Province, China
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Alsahwan AG, Alfaraj ZM, AlSafwani J, Bunaiyan AH, AlKhalifah RH, Al-Saba'a SA, Al-Momen SA, Aldolah Q. Rare gastric neoplasm: Malignant glomus tumor of the stomach. A case report. Int J Surg Case Rep 2021; 81:105802. [PMID: 33887847 PMCID: PMC8045044 DOI: 10.1016/j.ijscr.2021.105802] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Glomus tumors are rare neoplasms that aris-e from neuromyoarterial canal or glomus body. They are mainly found in the peripheral soft tissue, extremities and rarely developed inside the gastrointestinal tract. In the gastrointestinal tract, the stomach is the most common site for the development of glomus tumors, and most often found in the antrum. Usually, the symptoms of gastric glomus tumors are non specific i.e (abdominal pain, GI bleeding and/or perforation) and possibly discovered incidentally during upper GI endoscopy. CASE PRESENTATION This is a-56-year-old-male, presented to the emergency department with upper GI bleeding i.e (melena), and signs of shock (HR: 110; BP:80/60), Blood tests showed Hemoglobin level: 5 g/dl. Resuscitation was started with IV fluid and transfusion of 4 units of PRBCs. After resuscitation, He gave a 10 days history of passing black tarry stool, palpitation, headache, dizziness, easily fatigability, malaise, and colicky epigastric abdominal pain. His abdomen was soft, lax with no tenderness, there was fullness at the left upper quadrant. Upper GI endoscopy was performed that showed a large gastric ulcer with adherent clots, necrotic base and oozing at the proximal part of the greater curvature, after that the bleeding was managed with a heater probe and epinephrine injections. The histopathological examination of the biopsy revealed a spindle and epithelioid tumor with the top differential diagnosis being GIST, however other submucosal lesions cannot be excluded. After that, He underwent exploratory laparotomy and wedge resection of the tumor. The final histopathology showed a malignant glomus tumor. CLINICAL DISCUSSION Due to overlapping clinical and radiological features between glomus, GIST and other submucosal lesions, the histopathological examination is considered to be the gold standard for the diagnosis. Surgical resection with negative margin is the treatment of choice for gastric glomus tumors. CONCLUSION Although gastric glomus tumor is a rare entity and accounts for 1% of all gastric mesenchymal tumors, it should be considered in the differential diagnosis, since preoperative biopsy is difficult and overlapping features with other submucosal lesions. Surgical treatment is the preferred option for gastric glomus tumor and long-term follow-up is required due to high metastatic and recurrence rate in the malignant type.
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Affiliation(s)
| | - Zainab M Alfaraj
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jihad AlSafwani
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | | | - Ridha H AlKhalifah
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | | | - Sami A Al-Momen
- Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Qassim Aldolah
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
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7
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Vieites Branco I, Silva JC, Pinto F, Pires F, Almeida A. Rare mesenchymal antral gastric tumors: Case reports of glomus tumor and plexiform fibromyxoma. Radiol Case Rep 2019; 15:71-76. [PMID: 31737150 PMCID: PMC6849420 DOI: 10.1016/j.radcr.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal stromal tumors account for the majority of the mesenchymal neoplasms of the gastric antrum, but other entities should also be considered. We present the case of a 70-year-old man with an ulcerated well-circumscribed polypoid submucosal mass in the gastric antrum which was proven to be a glomus tumor. CT showed progressive contrast enhancement. Magnetic resonance imaging showed a high T2 signal intensity and heterogeneous arterial contrast enhancement which became more homogeneous in later phases. We also present the case of a 50-year-old woman with a large polypoid mass occupying half the circumference of the distal gastric antrum that was proven to be a plexiform fibromyxoma. Contrast-enhanced CT and magnetic resonance imaging revealed a pattern of progressive and heterogeneous enhancement. Although gastrointestinal stromal tumors are the most frequent gastric mesenchymal neoplasms, other rare mesenchymal tumors such as glomus tumor and plexiform fibromyxoma may arise in the gastric antrum.
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Affiliation(s)
- Inês Vieites Branco
- Centro Hospitalar Vila Nova de Gaia – Espinho, Radiology Department, Rua Conceição Fernandes 1282, Vila Nova de Gaia, Portugal
- Corresponding author.
| | - João Carlos Silva
- Centro Hospitalar Vila Nova de Gaia – Espinho, Gastroenterology Department Rua Conceição Fernandes 1282, Vila Nova de Gaia, Portugal
| | - Fernanda Pinto
- LAP – Laboratório de Anatomia Patológica, Rua da Constituição 2087, Porto, Portugal
| | - Fernando Pires
- Centro Hospitalar Vila Nova de Gaia – Espinho, Radiology Department, Rua Conceição Fernandes 1282, Vila Nova de Gaia, Portugal
| | - Ana Almeida
- Centro Hospitalar Vila Nova de Gaia – Espinho, Radiology Department, Rua Conceição Fernandes 1282, Vila Nova de Gaia, Portugal
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8
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Zulfiqar M, Shetty A, Shetty V, Menias C. Computed Tomography Imaging of Non-Neoplastic and Neoplastic Benign Gastric Disease. Curr Probl Diagn Radiol 2019; 48:75-96. [DOI: 10.1067/j.cpradiol.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
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Abstract
RATIONALE Glomus tumors (GTs) are a rare disorder originating from the glomus of the anastomoses of small arteries, usually occurring in the subungual region of the fingertips or toes and seldom occurring in the stomach. We unintentionally found a case of a gastric glomus tumor (GGT) without any upper abdominal discomfort. The diagnosis of this disease was mainly by immunohistochemistry. PATIENT CONCERNS The patient presented to our hospital with intermittent right abdominal pain for 1 month. Abdominal computed tomography showed a nodular enhancement lesion in the gastric antrum. DIAGNOSES The patient was diagnosed with an ileocecal tumor and a gastric stromal tumor. INTERVENTIONS Surgical resection of the ileocecal and gastric tumors was performed. OUTCOMES Pathologic examination of gastric masses revealed GT. The operation was effective, and the patient was discharged from our hospital 7 days after surgery. Upon follow-up at 3 months, the patient was asymptomatic. LESSONS GTs are submucosal tumors rarely found in the stomach. Surgical resection is a good choice of treatment. The GGT lacked specific clinical and imaging features, and immunohistochemistry was essential in the diagnosis of GGT.
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Affiliation(s)
- Menghui Wu
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
| | - Tianyu Zhou
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
| | - Donghui Cao
- Department of Clinical Research, The First Hospital of Jilin University
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xueyuan Cao
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
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Rosales-López E, Salceda-Otero J, Angulo-Molina D, Posada-Torres J, Canchola-Aguilar M, Lozoya-Gonzalez D. Gastric glomangioma, differential diagnosis of gastrointestinal stromal tumors. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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11
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Rosales-López E, Salceda-Otero JC, Angulo-Molina D, Posada-Torres JA, Canchola-Aguilar MG, Lozoya-Gonzalez D. Gastric glomangioma, differential diagnosis of gastrointestinal stromal tumors. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2018; 83:72-74. [PMID: 28392052 DOI: 10.1016/j.rgmx.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 06/07/2023]
Affiliation(s)
- E Rosales-López
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
| | - J C Salceda-Otero
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México; Ultrasonido Endoscópico, Centro Médico ABC, Ciudad de México, México.
| | - D Angulo-Molina
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
| | | | | | - D Lozoya-Gonzalez
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
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12
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A gastric glomus tumor resected using non-exposed endoscopic wall-inversion surgery. Clin J Gastroenterol 2017; 10:508-513. [PMID: 29039113 DOI: 10.1007/s12328-017-0782-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
Gastric glomus tumors are extremely rare, constituting approximately 1% of gastric mesenchymal tumors. We report the case of a 45-year-old female patient in whom upper gastrointestinal endoscopy revealed a 3-cm submucosal tumor with a bridging fold in the posterior wall of the antrum of the stomach. Contrast-enhanced computed tomography revealed the tumor to be hypervascular in the arterial phase and exhibit continuous enhancement in the post-venous phase. Dynamic contrast-enhanced magnetic resonance imaging showed that the tumor was hypervascular in the early phase and persistently enhanced in the late phase. Endoscopic ultrasonography revealed a mosaic echo pattern. Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed. Immunohistochemical examination revealed that the tumor was positive for α-smooth muscle actin and synaptophysin, but negative for CD56, chromogranin A and C-kit. Furthermore, 1-2% of the tumor cell nuclei were Ki-67-positive. Thus, the preoperative diagnosis was a benign glomus tumor. The patient then underwent non-exposed endoscopic wall-inversion surgery (NEWS), and the tumor was completely resected. In conclusion, NEWS is an effective method for the treatment of gastric glomus tumors.
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Abstract
Glomus tumours are benign tumours typically arising from the glomus bodies and primarily found under the fingernails or toenails. These rare neoplasms account for <2% of all soft tissue tumours and are generally not found in the gastrointestinal tract. We report a case of a 40-year-old man presenting with recurrent epigastric pain and pyrosis. Endoscopy revealed a solitary tumour in the antrum of the stomach. Fine-needle aspiration biopsy was suspicious for a gastrointestinal stroma tumour. After CT indicated the resectability of the tumour, showing neither lymphatic nor distant metastases, a laparoscopic-assisted gastric wedge resection was performed. Surprisingly, histology revealed a glomus tumour of the stomach.
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Affiliation(s)
- Rebekka Troller
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christopher Soll
- Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
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14
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Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding. Case Rep Surg 2015; 2015:193684. [PMID: 26697255 PMCID: PMC4678096 DOI: 10.1155/2015/193684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/22/2015] [Indexed: 12/19/2022] Open
Abstract
A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.
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15
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Kato S, Kikuchi K, Chinen K, Murakami T, Kunishima F. Diagnostic utility of endoscopic ultrasound-guided fine-needle aspiration biopsy for glomus tumor of the stomach. World J Gastroenterol 2015; 21:7052-7058. [PMID: 26078584 PMCID: PMC4462748 DOI: 10.3748/wjg.v21.i22.7052] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/22/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
A 52-year-old man was referred for further investigation of a gastric submucosal tumor on the greater curvature of the antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass, which was primarily connected to the muscular layer of the stomach. We performed endoscopic ultrasound-guided fine-needle aspiration biopsy. The pathological examination showed proliferation of oval-shaped cells with nest formation, which stained strongly positive for muscle actin, and negative for c-kit, CD34, CD56, desmin, S-100, chromogranin, and neuron-specific enolase. Therefore, we performed laparoscopy and endoscopy cooperative surgery based on the preoperative diagnosis of glomus tumor of the stomach. The final histological diagnosis confirmed the preoperative diagnosis. Although preoperative diagnosis of glomus tumor of the stomach is difficult with conventional images and endoscopic biopsy, endoscopic ultrasound-guided fine-needle aspiration biopsy is an essential tool to gain histological evidence of glomus tumor of the stomach for early diagnosis.
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16
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Rimbaş M, Micu G. What kind of a gastric tumor is this? CURRENT HEALTH SCIENCES JOURNAL 2015; 41:70-72. [PMID: 30151253 PMCID: PMC6057530 DOI: 10.12865/chsj.41.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/18/2022]
Abstract
This case report describes a gastric small submucosal tumor endosonographically resembling a gastrointestinal stromal tumor (GIST). The presence of calcifications inside prompted for the surgical excision, and the pathologic examination revealed in fact the presence of a glomangioma (glomus tumor). The presented case is an illustration of the fact that not all masses arising from the muscularis propria layer are GISTs, and the endosonographer must always think of alternative diagnoses.
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Affiliation(s)
- M Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania, Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - G Micu
- Pathology Department, Colentina Clinical Hospital, Bucharest, Romania
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Combined EUS and CT for evaluating gastrointestinal submucosal tumors before endoscopic resection. Eur J Gastroenterol Hepatol 2014; 26:933-6. [PMID: 24922355 DOI: 10.1097/meg.0000000000000136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
GOALS The aim of this study was to evaluate the combination of endoscopic ultrasonography (EUS) and computed tomography (CT) in predicting the maneuvers for therapeutic endoscopy for gastrointestinal submucosal tumors (SMTs). METHODS Patients with SMTs, who were scheduled for endoscopic resection, were randomized to preoperative performance of both EUS and CT (group A) or EUS only (group B). The following data were collected: therapeutic maneuvers, duration of procedure, dose of propofol, resected lesion size, and complications. RESULTS A total of 36 patients were included in group A and 36 patients were included in group B. Endoscopic submucosal excavation was performed in 43 patients, endoscopic full-thickness resection in 18 patients, and submucosal tunneling endoscopic resection in 11 patients. No significant differences were observed between the two groups (P>0.05). The coincidence rate between the preoperative program and the actual endoscopic procedures in group A was higher than that in group B (83.3 vs. 61.1%, P<0.05). The procedural time in group A was less than that in group B (39.36±17.83 vs. 48.06±12.03 min, P<0.05), and the dose of propofol in group A was less than that in group B (249.18±125.12 vs. 304.16±102.61 mg, P<0.05). The mean resected lesion size was 2.32±1.46 cm in group A and 2.12±0.75 cm in group B, without differences (P>0.05). A total of 14 cardiopulmonary complications and seven endoscopic complications occurred, without significant differences between the two groups (P>0.05). CONCLUSION EUS combined with CT can better evaluate SMTs compared with EUS only in predicting the maneuvers for therapeutic endoscopy.
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Chen KB, Chen L. Glomus tumor in the stomach: A case report and review of the literature. Oncol Lett 2014; 7:1790-1792. [PMID: 24932234 PMCID: PMC4049669 DOI: 10.3892/ol.2014.1986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 02/18/2014] [Indexed: 12/11/2022] Open
Abstract
This study reports a rare case of a 47-year-old female with a gastric glomus tumor who was admitted with epigastralgia. Endoscopic ultrasound revealed a protrusion on the posterior wall of the gastric antrum. Enhanced computed tomography confirmed the presence of a 10-mm mass. The tumor was resected, and immunohistochemistry revealed the tumor to be positive for smooth muscle actin and collagen type IV, and negative for synaptophysin, chromogranin A, laminin, S-100, cluster of differentiation (CD)34, CD31, CD99, cytokeratin (AE1/AE3), desmin and epithelial membrane antigen. The proliferation marker Ki-67 was positive in <5% of tumor cell nuclei. The clinical procedures with a review of the literature are reported.
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Affiliation(s)
- Kai-Bo Chen
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Li Chen
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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A rare case of malignant glomus tumor of the esophagus. Case Rep Oncol Med 2013; 2013:287078. [PMID: 24455358 PMCID: PMC3877612 DOI: 10.1155/2013/287078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/17/2013] [Indexed: 02/08/2023] Open
Abstract
Glomus tumors are rare neoplasms that usually occur on the hands in a subungual location, or sometimes in palms, wrists or soles of the feet. They are described as purple/pink tiny painful lesions with a triad of pain, local point tenderness, and cold hypersensitivity. They are almost always benign, but rare malignant variants have been reported. They have also been reported to be present at unusual locations, like the lung, stomach, or liver. Gastrointestinal glomus tumors are extremely rare tumors and very few cases have been reported in the literature. Most that have been reported were usually benign in nature. A rare esophageal glomangioma, mimicking a papilloma, was reported in 2006. We report a case of glomangiosarcoma (malignant glomus tumor) in a 49-year-old female, who presented with symptoms of dysphagia including some spasm and hoarseness and subjective unintentional weight loss. On endoscopic exam, she was found to have a distal esophageal mass with malignant features. Radiologically, the mass had a size of about 8 cm on the CT scan without evidence of metastases. Pathology and immunostaining of the biopsy showed features resembling a malignant glomus tumor. She underwent an endoscopic and laparoscopic staging of the tumor along with ultrasound. Based on the laparoscopic findings, which were consistent with the preoperative diagnosis, she was scheduled for an esophagectomy. Histopathology and immunophenotypic features of the excised mass were consistent with a diagnosis of malignant glomus tumor.
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Surgical extirpation of glomus tumor from rare localization on the upper extremity. Case Rep Vasc Med 2013; 2013:570945. [PMID: 24187644 PMCID: PMC3800625 DOI: 10.1155/2013/570945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/28/2013] [Indexed: 12/03/2022] Open
Abstract
Objective. To report on a very rare case of a glomus tumor manifested on the upper arm in a healthy young male patient. Case Presentation and Intervention. A 22-year-old male patient presented with bluish multifocal venous malformation on the left upper arm and was admitted for venous malformation excision. Pain, discomfort, and upper arm paraesthesia had been present for almost 6 years. Ultrasonography revealed septet tumor without blood flow in the subcutaneous region of anterior aspect of the upper arm. A multifocal venous malformation approximately 5–10 mm in diameter was excised. Histological examination showed dilated vascular area with proliferated glomus cells with round nucleus in the wall of dilated vascular structures. Based on histological examination, the final diagnosis was made as “glomangioma.” Conclusion. Histological examination is the only method that can establish final diagnosis. Currently, the only available treatment for this type of tumor is surgical excision.
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