2716 A Rare Case of Gastric Glomus Tumor

Abstract

INTRODUCTION: Glomus tumors are benign mesenchymal neoplasms found predominantly in the extremities. Involvement of the GI tract is rare (<2%). Stomach is the most common site in GI tract.(1) Clinical presentation is usually nonspecific and diagnosis is made based on pathological study after surgical resection. We describe the case of a 35 year old male presenting with upper GI bleeding found to have glomus tumor during endoscopy. CASE DESCRIPTION/METHODS: A 35 years old male with past medical history of musculoskeletal low back pain, who was on meloxicam for past several weeks presented to the hospital with complaints of black tarry stool and lightheadedness. This was associated with weight loss. On examination, he was hemodynamically stable, was found to have pallor, there was no icterus. He had mild epigastric tenderness. Esophagogastroduodenoscopy (EGD) was done that showed moderate inflammation with edema, erythema, friability and granularity around the gastric body and the gastric antrum. It revealed a large submucosal non-circumferential mass in the gastric body with no bleeding and no stigmata of recent bleeding (Figure 1). Contrast enhanced CT scan was obtained that revealed a 3 cm enhancing soft tissue mass. Endoscopic ultrasound (EUS) showed an intramural lesion in the body of stomach that appeared to originate from within the muscularis propria (layer 4) (Figure 2). Fine-needle aspiration (FNA) was performed that was positive for neoplastic cells. He underwent laparoscopic resection of gastric mass (3 cm × 3 cm). Biopsies showed a basaloid proliferation of cytologically bland cells growing in nodules with focal areas of fibrosis, some tumor cells showed cytoplasmic clearing. Tumor cells were positive for smooth muscle actin, calponin, h-caldesmon, synaptophysin, desmin. Final diagnosis of glomus tumor of the stomach was made. DISCUSSION: Diagnosis of glomus tumor should be considered in a patient with gastric submucosal mass. The diagnosis is usually by pathology and immunohistochemistry (2). Most of the tumors are benign in nature, malignant changes are rare. They need long term follow up to look for recurrence.