Gastric Glomus Tumor

Abstract

Purpose: Gastric glomus tumors are rare neoplasms originating from modified smooth muscle cells of glomus bodies. Glomus bodies are temperature sensitive neuromyoarterial receptors that help regulate arterial blood flow. We describe a rare occurrence of a patient with a gastric glomus tumor. Case: A 62 year old white man presented with a one month history of lower abdominal pain radiating to the back, exacerbated by bending or stooping. He complained of decreased appetite, nausea and vomiting, but denied weight loss, fever or chills. On physical exam he was afebrile and vital signs were normal. He was in obvious discomfort. Bowel sounds were normoactive. His abdomen was soft, tender over the RUQ. There was no obvious organomegaly or discrete mass. Labs revealed a WBC count 8.3 k/uL, Hgb 12.9 g/dL and platelets 361 k/uL. Amylase, lipase and complete metabolic panel were unremarkable except for albumin 2.8 g/dL and globulin 4.1 g/dL. CT abdomen without contrast showed a 2.8 cm mucosal mass near the anterior gastric body. Esophagogastroduodenoscopy (EGD) revealed a 3 cm submucosal mass with two small centrally located ulcers in the distal gastric body. Biopsies revealed atypical lymphoid infiltrate suspicious for a lymphoproliferative disorder. Repeat EGD with biopsies was unremarkable for flow cytometry; histology revealed gastric glomus tumor and chronic active H. pylori gastritis. Endoscopic ultrasound revealed an oval intramural (subepithelial) heterogeneous lesion originating from the muscularis propria (Layer 4) with well defined outer borders and an intact interface between the mass and adjacent structures, suggesting lack of invasion. Transgastric fine needle aspiration revealed a lesion infiltrated by round, uniform cells with moderate amounts of cytoplasm amid numerous large vessels. Immunostains were positive for muscle specific actin and vimentin and negative for leukocyte common antigen and chromagranin. Cytopathology and flow cytometry were unremarkable. A diagnosis of gastric glomus tumor and chronic active H. pylori gastritis was made. Laparoscopic excision of the 2.5 × 2.3 × 1.9 cm tumor was performed with free margins, three (0/3) negative perigastric lymph nodes and no evidence of vascular invasion. Pathology interpreted as glomus tumor of the stomach. Discussion: Although they may be located anywhere in the body, glomus tumors are most commonly found in the distal peripheral soft tissues of the fingers and toes. Gastric glomus tumors are rare, and generally considered benign solitary neoplasms. However, cases of multiple glomus tumors of the stomach and gastric glomus tumor with liver metastasis have been described and therefore, surgical resection is generally recommended. Methods: N/A Results: N/A Conclusion: N/A