Diagnosis Of Gastric Glomus Tumor Research Articles

Glomus tumor of gastric antrum: A rare differential

Introduction: Gastric glomus tumor is a rare clinical entity. Surgical excision could be avoided in selected patients if the diagnosis of glomus tumor could be made preoperatively. Cross-sectional imaging and endoscopic ultrasound (EUS) provide vital clues to nudge us in the right direction; however, these are inconclusive. Histopathology remains the gold standard for diagnosis of this condition. Case Report: We report a case of a man in his 60s who presented to the surgical outpatient clinic with long-standing history of abdominal bloating and discomfort. Upper gastrointestinal endoscopy revealed a submucosal lesion, and contrast-enhanced computed tomography (CECT) of the abdomen revealed a homogeneously enhancing lesion in the antrum of the stomach. Following successful surgical excision, histopathological examination established the diagnosis of gastric glomus tumor. This case presentation elaborates on the clinical features of this rare clinical entity and the various options available for diagnosis and management. Conclusion: Glomus tumors are rare mesenchymal tumors that need to be differentiated from other submucosal lesions and should be considered as a differential for submucosal lesions in the distal stomach. Endoscopic ultrasound and CT findings may provide clues to guide us toward the diagnosis; however, diagnosis can be confirmed only with histopathology. Surgical excision with negative margins either by laparoscopic or open operation is the treatment of choice.

Endoscopic ultrasonography diagnosis of gastric glomus tumors.

BACKGROUNDA gastric glomus tumor is relatively rare, and there is little knowledge on its endoscopic ultrasound findings.AIMTo assess the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of gastric glomus tumor and to discuss its value by reviewing the literature.METHODSA 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).RESULTSAll 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. CONCLUSIONAlthough glomus tumor of the stomach is relatively rare, a typical glomus tumor of the stomach has characteristic changes under EUS.

The Role of Endoscopic Ultrasound and Endoscopic Resection for Gastric Glomus: A Case Series and Literature Review.

Background and ObjectivesPreoperative diagnosis of gastric glomus tumor is very difficult, and there are few reports regarding the endoscopic treatment of glomus tumor of the stomach. Our aim is to provide a retrospective assessment of the imaging features of endoscopic ultrasound (EUS) and treatment of choice of gastric glomus tumor.MethodsA database of all patients with gastric glomus tumor who was treated at Shengjing Hospital of China Medical University between March 2011 and March 2017 was retrospectively analyzed. The EUS characteristics and patients’ clinical data as well as their treatment were reviewed. At the same time, we compared EUS characteristics of gastric glomus tumor with that of gastrointestinal stromal tumor (GISTs), leiomyomas, schwannomas, and ectopic pancreas.ResultsEleven patients (3 male and 8 female patients) were included in the present study. The patients’ age ranged from 37 to 62 years (mean age, 50.1 years). Ten patients received EUS examination. Eight lesions were presented with mild-hyperechoic round or oval mass; one lesion was mild-hyperechoic oval mass with hypoechoic spots; one lesion was hypoechoic oval mass. One patient received endoscopic full-thickness resection; 3 patients were treated by endoscopic submucosal dissection; and laparoscopic resection was performed for 7 patients.ConclusionsGastric glomus has typical EUS features to differentiate from other submucosal tumors. Compared with surgery, endoscopic resection is also a safe and effective treatment of choice for gastric glomus tumor.

Glomus tumor of the stomach treated by laparoscopic distal gastrectomy: A case report

Glomus tumor of the stomach is a rare submucosal mesenchymal tumor. The present study reports a patient with gastric glomus tumor treated by laparoscopic distal gastrectomy. A 39-year-old male was referred to Kochi Medical School Hospital for examination of a gastric submucosal tumor (SMT) initially diagnosed following a medical check-up. Esophagogastroduodenoscopy revealed a solitary, well-defined, submucosal lesion in the antrum of the stomach. Endoscopic ultrasonography (EUS) revealed a hypoechoic solid mass primarily connected to the gastric muscular layer. Abdominal contrast-enhanced computed tomography confirmed a 1.5 cm, well-defined mass lesion demonstrating homogeneous strong enhancement in the gastric antrum. Subsequent EUS-guided fine-needle aspiration produced a clinical diagnosis of neuroendocrine neoplasm and the patient underwent laparoscopic distal gastrectomy with regional lymph node dissection. Histopathology revealed solid proliferation of round, α-smooth muscle actin-immunopositive tumor cells with dilated vessels lined by endothelial cells without atypia, prompting a diagnosis of gastric glomus tumor. To the best of our knowledge, this is the seventh case of gastric glomus tumor treated by laparoscopy reported in English literature. The present case suggested that glomus tumor should be considered in the differential diagnosis for SMT of the stomach.

Gastric Submucosal Bleeding Tumor. Do You Think about Glomus Tumor of Stomach?

Glomus tumor is a rare mesenchyme tumor of the gastrointestinal tract, especially of stomach. We describe unusual presentation of gastric Glomus tumor of 76-year-old patient who presented with upper gastrointestinal bleeding. Subsequent investigation showed tumor of 3 cm at the posterior wall of the stomach. A wedge resection of the tumor was performed using laparoscopic staplers. The histological examination and immunohistochemical stains confirmed diagnosis of gastric Glomus tumor. We discuss the management before operation, the problems of diagnosis and surgical treatment of the patient with unusual location and presentation of the lesion.

Computed tomography and clinical characteristics of gastric glomus tumors.

To provide a retrospective assessment of clinical characteristics of the patients with gastric glomus tumors and the imaging features of the tumors on multidetector row computed tomography (MDCT). Consecutive patients with gastric glomus tumor which was confirmed by postoperative pathology from January 2004 to January 2012 in a tertiary hospital were included in the study. The MDCT images and medical records of the patients including the imaging features of the tumor on MDCT such as its location, number, shape, growth pattern, size, density and enhancement pattern were retrospectively reviewed. Altogether ten patients were included in the study, including seven women and three men, with a mean age of 46.6 years (range 25-67 years). Most patients had nonspecific clinical symptoms. All lesions were located at the gastric antrum, with a mean diameter of 2.7 cm. The gastric glomus tumor showed strong enhancement at the arterial phase, a progressive filled-in enhanced pattern and prolonged enhancement during multiphasic scans. Gastric glomus tumor is clinically an extremely rare disease. The combination of tumor location, size and the characteristic enhancement pattern of the subepithelial lesion may suggest a diagnosis of gastric glomus tumor.

Diagnosis of Gastric Glomus Tumor by Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy

Diagnosis of Gastric Glomus Tumor by Endoscopic Ultrasound-Guided Fine-Needle Aspiration Biopsy

Think Zebra: An Unusual Cause of Nausea, Vomiting, and Abdominal Pain

Purpose: Case: A 42-year-old Hispanic male presented with nausea, vomiting, epigastric pain since March 2010. He was hospitalized with similar complaints in April 2010. A CT scan of abdomen and pelvis revealed cholelithiasis without associated cholecystitis. Due to his recurrent symptoms, he underwent laparoscopic cholecystectomy in May 2010. His symptoms partially improved following surgery, but recurred soon after. In February 2011, he presented to the emergency department with worsening nausea, vomiting, and epigastric pain. A repeat CT scan of abdomen and pelvis was unremarkable. Subsequently, an esophagogastroduodenoscopy (EGD) was done which demonstrated submucosal antral mass. An endoscopic ultrasound (EUS) revealed a 2.6 x 2.4 cm homogenous hypoechoic lesion arising from muscularis propria in the antrum. Fine needle aspiration (FNA) biopsy was obtained, but the final pathology report was non-diagnostic. The patient underwent partial gastrectomy. Pathologic examination of the tumor tissue was strongly positive for smooth muscle actin and negative for CD117, CD 34, CD 31, desmin, chromogranin, synaptophysin, and CAM 5.2. The immunohistochemical and histologic features support a diagnosis of gastric glomus tumor. Postoperatively, the radiologists were notified of the diagnosis and were asked to review the pre-operative CT scan images. Once again, the mass was not visualized on the images. Patient tolerated the surgery well and was discharged home. His symptoms never recurred, and he is waiting surveillance EGD in a year after surgery. Discussion: Gastric glomus tumor is a rare benign mesenchymal neoplasm that originated from neuromyoarterial glomus. The first case of gastric glomus tumor was reported in 1951, and the incidence is estimated to be only 1% out of all gastrointestinal stromal tumors. Patients may present with non-specific symptoms such as epigastric discomfort, nausea, vomiting or melena. Only a few cases of metastatic gastric glomus tumor were described in the literature, and the liver is the common site. Those tend to be size of greater than 2 cm, deep gastric location, and high mitotic activity. The preoperative diagnosis is challenging due to the insensitivity of CT scan, non-specific EGD findings, and non-diagnostic FNA biopsy result due to intramural localization of the mass. Conservative local resection is the gold standard for both diagnosis and treatment. However, endoscopic enucleation is also under consideration. Overall, gastric glomus tumor has favorable prognosis after resection. Although rare, gastric glomus tumor should be included in the differential diagnosis in patients presenting with non-specific upper gastrointestinal symptoms.

Gastric Glomus Tumor - A Rare Differential of Submucosal Gastric Tumors

Purpose: A 50 yr old female with intermittent epigastric pain and past history of diabetes was referred for upper endoscopy (EGD). Physical examination was unremarkable. Hematological and liver profiles were normal. EGD showed a 3 cm submucosal mass with superficial ulceration in the gastric antrum. Endoscopic biopsies were non diagnostic. EUS identified a 3.7 mm submucosal hypoechoic mass arising from the muscularis propria with an anechoic center suggesting fluid or central necrosis. FNA showed benign glandular epithelium and was not diagnostic. No liver involvement or lymphadenopathy was identified on CT scan. Exploratory laparotomy revealed a discreet mobile rubbery mass in the antrum which was excised. Liver and peritoneal surfaces appeared normal. The excised tumor stained for vimentin, actin, synaptophysin and was negative for CD 34, desmin, chromogranin, CD 117 and cytokeratin. Based on histopathology and immunohistochemistry, a final diagnosis of gastric glomus tumor was made. Gastric glomus tumors are mesenchymal neoplasms arising from the neuromyoarterial glomus. These tumors are commonly observed in the dermis or subcutis, but only rarely found in the stomach. The frequency of these tumors is around 1% of gastrointestinal stromal tumors. The tumors typically present with epigastric pain or gastrointestinal bleeding from mucosal ulceration. They are usually solitary and located in the antrum. Endosonographic images in glomus tumors of the stomach show a solid, submucosal tumor with or without ulceration and do not differentiate it from other more common tumors. Also the diagnostic accuracy of EUS guided FNA ranges from 50-90%, therefore the final diagnosis is usually established on a resected specimen on histopathology and immunohistochemistry. Histopathological features of small, uniform, round to polygonal tumor cells surrounding capillaries, staining strongly positive for smooth muscle actin and vimentin establish the diagnosis. Although usually benign, malignant transformation has been reported with size > 2cm, deep location, high nuclear grade or > 5 mitosis/50 hpf being poor predictors. The absence of CD 117, CD 34, chromogranin A, neurone specific enolase, cytokeratin, S-100 stains on immunohistochemistry differentiates glomus tumors from other more common lesions, such as GIST, paraganglioma and carcinoid tumors, which may have similar histological features. We conclude that gastric glomus tumors are essentially benign in nature and may be mistaken for other more common mesenchymal tumors. Preoperative recognition of these tumors may spare the patient a more extensive surgical resection though larger gastric glomus tumors may require close follow-up if other poor predictors are present.

Endoscopic diagnosis and treatment of gastric glomus tumors

Although gastric glomus tumors are usually benign lesions, occasional malignant transformation has been reported. Thus, complete resection of the gastric glomus tumor is necessary. To provide a better understanding of the endoscopic features of this rare entity with an emphasis on its diagnosis and treatment. Retrospective case series. Academic medical center. Six patients (2 men, 4 women; median age 48 years) received a diagnosis of gastric glomus tumor and were treated. Endoscopic diagnosis and resection. Endoscopic features, resection success, adverse events, and follow-up endoscopy. Gastric glomus tumors do not exhibit specific features on gastroscopy and EUS that distinguish them from other gastric submucosal tumors. Endoscopic submucosal enucleation was successful in 5 patients. In one patient, the operation had to be discontinued because of significant bleeding during the procedure. The mean tumor size was 19.8±6.2 mm (range 12-30 mm). Perforation occurred in 1 patient and was successfully managed with hemoclips. No local recurrence was observed during follow-up (mean duration 9±5.1 months, range 3-17 months). Small number of patients (N=6), limited follow-up, retrospective study. Diagnosis of gastric glomus tumors is difficult when based only on features derived from gastroscopy and EUS. Endoscopic submucosal enucleation is a feasible and safe procedure with which to diagnose and treat this lesion. However, further investigation and comparative studies are required to confirm the safety and efficacy of this method.

Gastric Glomus Tumor: Preoperative Diagnosis with EUS/FNA

Purpose: Gastric Glomus tumors are rare benign submucosal neoplasms that may be difficult to differentiate, with available imaging modalities including EUS, from the other submucosal tumors of the stomach namely gastrointestinal stromal tumors (GIST), Leiomyomas, Schwannomas, neuroendocrine tumors, etc. The diagnosis, thus, rests on the histological examination and immunohistochemistry. Endoscopic ultrasound with fine needle aspiration appears to be an ideal tool for obtaining material for preoperative diagnosis. A search of literature, however, shows only 2 cases where FNA was successfully employed in obtaining tissue for these tests. We report a case of gastric glomus tumor that was diagnosed preoperatively by EUS/FNA, at our center. Methods: A 44 year old woman presented with vague epigastric pain, dyphagia and nausea. She had had an upper GI barium study at an outside facility showing a filling defect in distal antrum along the lesser curvature of the stomach. A CT scan of the abdomen was ordered and an EGD/EUS was scheduled. The CT scan showed an enhancing, submucosal lesion along the posterior/superior aspect of the gastric pylorus, measuring 3.1 × 2.4 × 2.4 cm with intact underlying gastric mucosa. EUS revealed a 3.5 cm heterogeneous, hypoechoechoic circumscribed mass originating in the 3rd layer, with Doppler evidence of blood flow. FNA was obtained without any complications. Results: The pathology was reported as showing neoplastic epithelioid proliferation with signet ring like features. Immunohistochemistry, however, clarified the diagnosis with demonstration of positivity with smooth muscle actin, muscle specific actin, vimentin and collagen type IV; and negative reactivity with CD117, CD34, S100, keratin, chromogranin and synaptophysin. This immunohistochemical profile supported the diagnosis of glomus tumor. As the tumor exceeded the 2 cm size limit for it to be considered low risk for malignancy, she went on to have surgery with stomach antrectomy. A tumor 3.5 cm in greatest dimension was thus resected. Pathology was consistent with the earlier preoperative diagnosis; and no evidence of malignancy was found. Conclusion: Although in the experience of other operators the FNA and pathology have not always been conclusive in the diagnosis of gastric glomus tumor, our limited experience has been otherwise. This case illustrates a rare neoplasm that was successfully diagnosed preoperatively with EUS/FNA.

Gastric Glomus Tumor

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