Gastric Glomus Tumor Research Articles

Gastric glomus tumor in a patient with biliary colic: a rare case report with literature review

Introduction: Glomus tumor (GT) mainly occurs in the extremities. Its appearance elsewhere has rarely been reported. This study aims to report an incidental finding of gastric GT in a patient with biliary colic. Case presentation: A 45-year-old female presents with moderate to severe upper abdominal pain. Physical examination was performed, the abdomen was soft, nontender, and no mass felt. Transabdominal ultrasound showed a single stone in the gallbladder, normal wall thickness, and no biliary dilatation. The diagnosis of biliary colic was achieved based on the clinical presentation, examination findings, and test results. Wedge resection of the stomach with open cholecystectomy was performed. Histopathology result was compatible with gastric GT. Clinical discussion: The clinical examination of GT is much similar to other tumors like hemangioma, lipoma, gastrointestinal stromal tumor, and leiomyoma. Concerning diagnosis, GT is mostly intersecting with gastrointestinal stromal tumors, mainly in small biopsy screening. For this reason, most of the gastric GT can be identified preoperatively as gastrointestinal stromal tumors. Conclusion: Gastric GT is an uncommon benign tumor that can be found incidentally during the diagnosis of other diseases or tumors because of its clinical and radiologic similarities.

Computed tomography features and clinicopathological characteristics of gastric glomus tumor

BackgroundGastric glomus tumor (GGT) is a rare neoplasm that is difficult to distinguish from other gastric submucosal tumors due to a lack of diagnostic experience. The goal of this study was to better understand GGT by looking at its clinicopathological features, computed tomography (CT) features, and differential diagnosis.MethodsThe clinical data and CT findings of 21 pathologically confirmed GGT patients were examined. The clinical characteristics and CT findings of benign GGT were compared to gastric stromal tumors (GST) (n = 30) and heterotopic pancreas (n = 30).ResultsThe 21 cases included six males and fifteen females ranging in age from 42 to 64 years. The lesions were found in the gastric body in four cases and the antrum in seventeen. GGT was diagnosed as benign in 20 cases and malignant in one. In benign cases, the glomus cells were small, uniform, showed perivascular hemangiopericytoma‑like or solid nest‑like structures. Obvious mitotic figures were observed in the malignant case. SMA staining was positive in the tumor cells. A quasi-round or round solid mass protruded into the gastric cavity in 20 benign cases, with a clear and smooth edge. The long to short diameter ratio was 1.01 ± 0.15. All of the benign cases had obvious enhancement, with homogeneous enhancement in ten cases and heterogeneous enhancement in ten cases, as well as central filling enhancement in 12 cases. The ratio of CT value of lesion to abdominal aorta in arterial phase and venous phase were (0.41 ± 0.11) and (0.81 ± 0.20), which were significantly higher than GST and heterotopic pancreas. The irregular mass broke through the gastric wall and invaded liver with poorly defined boundary and internal necrosis, heterogeneous persistent moderate enhancement with thickening blood supply arteries was seen in one malignant case with a long diameter of 150 mm and a thick diameter of 30 mm.ConclusionsCT enhancement usually shows persistent obvious enhancement, especially in arterial phase, which provides important value for the diagnosis. CT findings can help in the differential diagnosis of GGT and other submucosal tumors.

Gastric Glomus Tumor: A Case Report

Glomus tumor is an uncommon mesenchymal neoplasm usually described in the distal extremities, and rarely involving visceral organs. We report the case of a 27-year-old Filipino female with a history of low hemoglobin count and a submucosal gastric mass. This was demonstrated on microscopic and immunohistochemical studies to be a gastric glomus tumor (GGT). Although rare, GGTs should be part of the differential diagnoses of submucosal gastric masses.

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.

S3194 Gastric Glomus Tumor Diagnosed on Upper Endoscopy: A Case Report

S3194 Gastric Glomus Tumor Diagnosed on Upper Endoscopy: A Case Report

Gastric glomus tumor: a\xa0case report and review of the literature

IntroductionGastric glomus tumor is a rare mesenchymal neoplasm. There are only a few cases of the tumor showing malignancy, and there are no specific guidelines for the management of this entity.Case presentationWe present the case of a 53-year-old Caucasian male who was hospitalized for anemia. Computerized tomography of the abdomen depicted a mass between the pylorus of the stomach and the first part of the duodenum. Preoperative diagnosis was achieved with pathology examination of the biopsies taken via endoscopic ultrasound and upper gastrointestinal endoscopy. An antrectomy with Roux-en-Y anastomosis and appendicectomy, due to suspicion of appendiceal mucocele, were performed. The patient had an uneventful postoperative recovery and was discharged 5 days later.DiscussionPreoperative diagnosis of a gastric glomus tumor is difficult owing to the location of the tumor and the lack of specific clinical and endoscopic characteristics. Furthermore, it is exceptional to establish diagnosis with biopsies taken through endoscopic ultrasound or upper gastrointestinal endoscopy, prior to surgical resection. Although most glomus tumors are benign and are not known to metastasize, there are rare examples of glomus tumors exhibiting malignancy. Treatment of choice is considered wide local excision with negative margins. However, long-term follow-up is required as there is the possibility of malignancy.ConclusionThe aim of this report is to enlighten doctors about this uncommon pathologic entity. Surgical resection is considered the golden standard therapy to establish a diagnosis and evaluate the malignant potential.

Les tumeurs glomiques gastriques. Intérêt des biopsies sous échoendoscopie pour le diagnostic. À propos de deux cas

Glomus tumors are rare mesenchymal tumors, mostly benign, although a few malignant cases have been described in the literature. These tumors are usually localized subcutaneously or subcutaneously, however they may exceptionally be gastric localized. We report two new observations diagnosed on biopsies performed by echo endoscopy. The first was a 66-year-old man and the second a 78-year-old man. In both cases, the lesions were on astral, nodular, and very limited location. The biopsies revealed a tumor proliferation of trabecular architecture, composed by monomorphic cells, with eosinophilic cytoplasm, medium size, with a rounded, regular nucleus, without mitosis or necrosis, with distended and branched capillaries on the periphery. In immunohistochemical studies, tumor cells expressed smooth muscle actin and caldesmone. The proliferation index KI 67 was very low. In practice, however, preoperative diagnosis remains difficult because there is no typical appearance in imaging or echo-endoscopy to distinguish them from other gastric parietal tumors. To date, there is no consensus on the therapeutic management of gastric glomus tumors. However, endoscopic resection by dissection under the mucosa associated with endoscopic monitoring seems to be a method of choice as well as a way to postpone open or laparoscopic surgery, especially when these tumors are small (<30mm).

Gastric glomus tumor: Endoscopy, MD-CT and pathologic features

Gastric glomus tumor: Endoscopy, MD-CT and pathologic features

S3013 The Two Challenges in Management of Gastric Glomus Tumors

INTRODUCTION: Gastric glomus tumors (GGTs) are rare gastrointestinal lesions originating from the neuromuscular arterial canal or vascular lumen which share many overlapping features with other stromal lesions. Even though most cases of GGTs are benign, there is lack of reliable histological features predictive of tumor behavior. CASE DESCRIPTION/METHODS: A 42-year-old male with hypertension and gastroesophageal reflux disease presented with a history of intermittent left upper quadrant pain and non-bloody, non-bilious emesis. He was afebrile and had a soft, non-distended abdomen. Labs were notable only for mild iron deficiency anemia. Contrast-enhanced computed tomography (CT) of the abdomen showed a 3.2 × 2.7 × 3.1 cm soft tissue mass with central calcification and vascularity along the lesser curvature of the stomach. Esophagogastroduodenoscopy (EGD) demonstrated a 3 cm submucosal ulcerated mass at the incisura (Figure 1). Endoscopic ultrasonography (EUS) showed a well-defined hypoechoic lesion arising from the muscularis propria, with maximum diameter of 3.3 cm (Figure 2). Further investigation with fine needle aspiration (FNA) of the lesion demonstrated – small, round and uniform cells intermixed with capillary-sized vessels along with in-tumor-calcification, mild pleomorphism, and sparse Ki67 staining, but no evidence of mitotic activity (Figure 3A) which demonstrated positivity for smooth muscle actin and synaptophysin and weak stained for placental alkaline phosphatase suggestive of a glomus tumor (Figure 3B). The tumor cells lacked markers more indicative of an epithelioid gastrointestinal stromal tumor including: CD117, CD34, Desmin, S-100, and DOG1. After discussing surveillance versus endoscopic/surgical resection options with the patient, surgical wedge resection of the tumor was performed for definitive management. Pathology of excision specimen was consistent with a benign gastric glomus tumor. DISCUSSION: GGTs pose two challenges: 1) differentiation from more common stromal/mesenchymal tumors and 2) prediction of tumor behavior. In our patient, although EUS and FNA showed small benign cells, given the patient’s young age, symptomatic presentation, ulcerated lesion appearance and neovascularity, we proceeded with resection after shared decision making. Given the rarity of GGTs, this case highlights the importance of establishing an accurate diagnosis and the various factors that must be taken into consideration to best determine malignant potential.Figure 1.: A) EGD of pre-pyloric stomach showing multiple, small non-bleeding erosions near the antrum (yellow arrows). B) EGD showing a large, submucosal mass with no bleeding and no stigmata of recent bleeding was found at the incisura (yellow arrows).Figure 2.: EUS showing a hypoechoic mass in the stomach incisura angularis (yellow arrows).Figure 3.: A) Hematoxylin and Eosin (H& E) staining of FNA (30x magnification). B) Smooth muscle actin (SMA) stain on FNA specimen which is characteristically positive in glomus tumors (16x magnification).

Differentiation of gastric glomus tumor from small gastric stromal tumor by computed tomography.

ObjectiveThis study was performed to investigate the value of computed tomography (CT) in the differentiation of gastric glomus tumors (GGTs) and small gastric stromal tumors (GSTs).MethodsFifty-nine patients with pathologically confirmed GGTs (n = 11) and GSTs (n = 48) from 2006 to 2019 were retrospectively evaluated. All patients’ preoperative CT imaging features were analyzed.ResultsThe following features were significantly different between GGTs and small GSTs: location in the antrum, endophytic growth, heterogeneous enhancement in the arterial phase, CT value in the arterial phase of ≥60.7 Hounsfield units (HU), CT value in the portal phase of ≥87.6 HU, degree of enhancement in the arterial phase of ≥29.9 HU, and degree of enhancement in the portal phase of ≥49.0 HU. A model including four randomly selected features among these seven criteria was built to differentiate GGTs from small GSTs with a sensitivity and specificity of 90.9% (10/11) and 100% (48/48), respectively.ConclusionWe identified seven features that are useful for differentiating GGTs from small GSTs. A combination of four of these seven criteria may increase the diagnostic accuracy.

Gastric glomus tumor: Endoscopy, MD-CT and pathologic features

Gastric glomus tumor: Endoscopy, MD-CT and pathologic features

Gastric Glomus Tumor: A Clinicopathologic and Immunohistochemical Study of 21 Cases.

Gastric glomus tumors (GGTs) are rare mesenchymal tumors. Most glomus tumors occur in the distal parts of the extremities. Here, we retrospectively analyzed the features of GGTs from two institutions. The histologic and clinical findings of all GGT cases from 2009 to 2018 were reviewed. The most common location was the antrum, the mean age of patients was 49.3 years, and the mean tumor size was 2.1 cm. Microscopically, small, round cell nodules surrounded the expansion of blood vessels in a nest pattern. Immunohistochemical assays for vimentin and smooth muscle actin (SMA) were positive, and assays for H-caldesmon and calponin were partially positive. GGT is rare and easily misdiagnosed before operation. However, immunohistochemistry is useful for the differential diagnosis. The majority of GGTs are benign, and local surgery achieving complete resection is the most effective treatment method.

Gastrointestinal glomus tumors: a clinicopathological analysis of fifteen cases

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of gastrointestinal glomus tumors (GIGT). Methods: Totally 15 cases of GIGT were collected at the First Affiliated Hospital, Zhengzhou University, from January 2011 to June 2018. The clinicopathological features, immunophenotype, BRAF V600E mutation and prognosis were retrospectively analyzed. Results: The 15 patients' age ranged from 37 to 59 years(median 49 years, mean 50 years). Eleven patients presented with intermittent abdominal pain and distention, three showed antral space-occupying lesions at physical examination, and one had abdominal pain accompanied by fecal blood. Fourteen tumors were located in the stomach, and one was in the ileum. Imaging showed the gastric glomus tumors were located in the submucosal layer with obvious enhancement in the arterial phase, and the ileum glomus tumor involved the whole layer of intestinal wall causing luminal obstruction. The maximum diameters of the tumors ranged from 1.5 to 3.0 cm (mean 2.3 cm). Grossly, the gastric glomus tumors were solid. Microscopically, the gastric glomus tumors were mostly located in the muscularispropria layer and were vascular. The tumor boundary was distinct but without capsule formation. The tumor cells were round or oval, and showed perivascular hemangiopericytoma-like or solid nest-like structures. The tumor cells were mildly pleomorphic, with rare mitosis and no necrosis. Two tumors had focal calcification, two showed mucosal invasion, two showed vascular invasion and five showed perineural invasion. The ileum glomus tumor was cellular, with prominent cellular atypia, and the mitotic count in hot spots was about 5-6/HPF. Immunohistochemistry showed that SMA and collage Ⅳ were strongly expressed in all the tumor cells; caldesmon and calponin were moderately expressed in some regions, and syn was weakly expressed in 12 cases. The Ki-67 proliferation index in the gastric glomus tumors ranged from 1% to 30% (mean 6%); and that in the ileum glomus tumor was about 70%. BRAF V600E mutations were not detected in any of 15 GIGTs. All patients did not receive radiotherapy or chemotherapy post operatively. Thirteen patients were followed up by telephone for 18-90 months (mean 42 months). Twelve patients with gastric glomus tumors survived without recurrence and metastasis, and the patient with ileum glomus tumor had liver metastasis 15 months after operation. Conclusions: Glomus tumors is a rare mesenchymal tumor of the gastrointestinal tract. It should be differentiated from gastrointestinal stromal tumors, neuroendocrine tumor, leiomyoma, solitary fibrous tumor and paraganglioma. Most GIGTs are benign and have good prognosis. More experience is needed to understand the biologic behavior and prognostication of GIGTs.

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.

Importance of Cytohistological Correlation and Diagnostic Utility of Endoscopic Ultrasound in Gastric Glomus Tumor: A Case Report

AbstractWe present a case of gastric glomus tumor (GGT) in a 60-year-old female patient presented with progressive dysphagia for both solid and liquid diagnosed with the help of endoscopic ultrasound (EUS)-guided fine-needle aspiration cytology with histological correlation and detailed immunohistochemistry evaluation. Till date, only seven cases were correctly diagnosed by EUS-guided aspiration cytology. We report this case to highlight the cytological features and importance of EUS in diagnosing GGT.

Cytomorphological features of glomus tumors arising in the stomach: A series of two cases diagnosed on FNA

• Gastric glomus tumors are rare mesenchymal tumors that should be included in the differential of gastric submucosal masses. • Cytologic features of glomus tumors are distinctive, but immunohistochemistry is required to help ascertain the diagnosis. • Endoscopic ultrasound-guided fine-needle aspiration can be used in the diagnosis of gastric intramural or submucosal lesions.

Laparoscopic endoscopic cooperative surgery for a gastric glomus tumor previously diagnosed by endoscopic ultrasound fine-needle biopsy

Laparoscopic endoscopic cooperative surgery for a gastric glomus tumor previously diagnosed by endoscopic ultrasound fine-needle biopsy

Gastric glomus tumour: A challenge in the preoperative diagnosis of stomach subepithelial lesions

Gastric glomus tumour: A challenge in the preoperative diagnosis of stomach subepithelial lesions

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.

Gastrointestinal Occurrence of a Glomus Tumor

Glomus tumors are benign subepithelial mesenchymal neoplasms generally found in the fingers. It is rare to find a glomus tumor in the gastrointestinal tract. This is a case of a gastric glomus tumor (GGT). It is important to understand the difference betwen a glomus tumor and a gastrointestinal stromal tumor (GIST), which is far more common. The patient is a 26 year old Caucasian female who, for the past one year, had been visiting the gastroenterology clinic with complaints of epigastric abdominal pain, constipation, diarrhea, and heartburn. She was a moderately built individual with no abnormal vitals or notable findings on physical examination. We decided to do an EGD, and a mass in the body of the stomach was discovered. CT abdomen revealed a high density nodular lesion. EUS showed a 2.5cm x 2.2cm submucosal mass with mixed echogenicity and cystic spaces, arising from the muscularis propria of the stomach wall. The biopsy was consistent with a neuroendocrine lesion. Neuroendocrine markers were negative. However, smooth muscle actin and vimentin were strongly immunoreactive. Serotonin levels were normal, and octreotide scan revealed a faint glow in the tumor. Surgery was consulted and laparoscopic partial gastrectomy was performed. Pathology of the wedge resection revealed a gastric glomus tumor 1.8cm in diameter with well-defined margins and no evidence of malignancy. Subepithelial tumors of the gastrointestinal tract include carcinoid tumors, lymphomas, glomus tumors, and GIST. GIST, being the most common, are thought to arise from the interstitial cells of Cajal of the autonomic nervous system of the intestine. Glomus tumors arise from the glomus body in the intramuscular layer, typically in the antrum of the stomach. Both appear on CT as well-circumscribed homogenous masses, and on EUS as hypoechoic masses. However, GGT can be distinguished from GIST based on immunohistochemisty. GIST is typically positive for c-kit (CD117), whereas GGT may test positive for smooth muscle actin, laminin, collagen type IV, desmin, and vimentin.2680_A Figure 1. MR Abdomen, showing a 2.2cm homogenously-enhancing subepithelial gastric antral wall mass.2680_B Figure 2. Microscopic examination, showing multiple blood vessels surrounded by round glomus cells.Even though EUS-FNA differentiates GTs from more aggressive gastric tumors with a 95.6% accuracy, surgery is still preferred. According to the National Comprehensive Cancer Network, if the GIST is >2cm it should be surgically resected. Even if there were any doubt between a GT or GIST, wedge resection is the therapeutic management of choice. This rare case taught us how to diagnose and treat a gastrointestinal glomus tumor.