Gastric glomus tumor: report of one case and review

A healthy 26-year-old woman presented with a year of intermittent epigastric pain but no other symptoms. Upper gastrointestinal endoscopy showed, on the anterior wall of the gastric body, a submucosal, elevated, well-defined lesion measuring 3 cm in diameter, with normal overlying mucosa ([Fig. 1]).

Fig. 1 Endoscopic image of a well-defined submucosal tumor with normal overlying mucosa.

Endoscopic ultrasonography showed a hypoechoic lesion arising from the muscularis propria, without deep involvement ([Fig. 2]), compatible with a gastrointestinal stromal tumor (GIST).

Fig. 2 Endoscopic ultrasound showing a tumor arising from the muscular layer.

The patient was operated on. A well-defined 2-cm tumor, without serosal involvement, was found on the anterior wall of the gastric body. A partial gastrectomy was done with 1-cm margins ([Fig. 3]).

Fig. 3 Findings at surgery. A rounded tumor in the anterior distal gastric body, with well defined borders. A local excision was performed.

The patient was discharged without problems.

The biopsy showed in the muscularis propria a well-defined stromal tumor made of vascular structures, covered by a single layer of endothelial cells, and with dense cellular proliferation around the vascular structures, with low mitotic rate (one or two mitoses per 50 high-power fields) and without necrosis. Immunohistochemical staining was positive for smooth muscle actin. The conclusion was that it was a glomangioma ([Fig. 4 a, b]).

Fig. 4 a Histopathology showing positive staining for smooth muscle actin. b Hematoxylin and eosin stain; low magnification. Nests of glomus cells surrounding capillary-size vessels.

Glomus tumors are rare. Nearly 75 % of glomus tumors are localized in the hands, under the nails [1]. They originate from the normal myoarterial apparatus and are constituted by an afferent arteriole and vascular channels with endothelial cells, surrounded by cuboidal cells [2]. Just 2 % of benign gastrointestinal tumors are vascular tumors; most are glomus tumors [3]. The majority are asymptomatic, and the diagnosis is incidental; upper gastrointestinal bleeding and ulcerous syndrome are the most frequent symptoms. Glomus tumors have a female predominance (2.5 : 1). The majority are benign and single, but the malignant potential is unpredictable [4] [5]. The peak incidence of glomus tumors is in the sixth decade of life. Diagnosis is generally done after surgery. During endoscopy, a submucosal mass similar to smooth muscle is generally found. Computed tomography (CT) shows an enhanced pattern with contrast. Histological studies show a low mitotic rate, positive staining for actin and calponin, and negative for c-kit, chromogranin and common leucocyte antigen, which differentiate GIST, carcinoids, and lymphoma respectively, the three differential diagnoses. The management is surgical resection for final diagnosis and treatment [5].

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

References

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• 2 Maehara Lde S, Ohe E M, Enokihara M Y et al. Diagnosis of glomus tumor by nail bed and matrix dermoscopy.  An Bras Dermatol. 2010;  85 236-238
• 3 Fabiani P, Benizri E, Michiels J F et al. A new case of gastric glomangioma.  Gastroenterol Clin Biol. 1993;  17 974-975
• 4 Alempijevic T, Knezevic S, Knezevic D et al. Gastric multicentric glomangioma: a case report of this rare cause of abdominal pain.  Med Sci Monit. 2008;  14 CS5-CS8
• 5 Lorber J, Kalish J, Farraye F A et al. Glomus tumor of the gastric antrum: case report.  Curr Surg. 2005;  62 436-438