Gastric glomus tumor with a preoperative diagnosis by endoscopic ultrasonography-guided fine needle aspiration: a case report

A case of gastric glomus tumor with metachronous liver metastasis after laparoscopic partial gastrectomy

INTRODUCTION AND IMPORTANCE

Gastric glomus tumor (GGT) is a rare submucosal mesenchymal tumor that is typically benign. However, GGT recurrence or metastasis has been reported.

CASE PRESENTATION

A 55-year-old man was referred to our hospital for gastric submucosal tumor (SMT) examination. Esophagogastroduodenoscopy revealed a 15 mm SMT in the anterior wall of the gastric antrum. Endoscopic ultrasonography demonstrated a hypoechoic solid mass that invaded the proper muscle layer. In contrast-enhanced abdominal computed tomography (CT), the anterior wall of the gastric antrum was thickened. Our provisional diagnosis was gastric leiomyoma. As the tumor grew rapidly, we performed laparoscopic partial gastrectomy. Histopathology revealed solid proliferation of tumor cells with oval-shaped nuclei. Immunohistochemically, the tumor cells were positive for alpha-smooth muscle actin and vimentin but negative for c-kit, CD34, desmin, and S-100. The MIB-1 labeling index was approximately 60 %. We then diagnosed the patient with GGT. After 2 years and 6 months, abdominal CT revealed metastatic lesions over 40 mm in diameter, with ring enhancement seen in segment 8 of the liver and another liver metastatic lesions 15 mm observed in segment 5/6. After being diagnosed with liver metastases of the GGT, the patient continued to receive chemotherapy for 26 months and was in good general condition.

CLINICAL DISCUSSION

Laparoscopic partial gastrectomy was performed for a rare GGT, revealing a case of asynchronous liver metastasis.

CONCLUSION

We managed a case of asynchronous liver metastasis of GGT.

Gastric glomus tumor with a rare presentation: a case report and review of the literature

Introduction and importance

Gastric glomus tumors (GGT) are rare soft tissue tumors of the gastrointestinal tracts (GIT). It is somewhat challenging to establish the diagnosis of GGT and differentiate it from the more common submucosal neoplasms.

Case presentation

A 34-year-old female patient presented with upper gastrointestinal bleeding. Extensive workup including endoscopic ultrasonography (EUS) revealed a well-circumscribed isoechoic mass arising from the muscularis propria. Based on fine needle biopsy (FNB) findings, with H&E stains performed only initially, the mass was considered a neuroendocrine tumor (NET). Antrectomy with Billroth II anastomosis was performed. A microscopic and immunohistochemical studies of the resected specimen showed the cells to be positive for smooth muscle actin (SMA) making GGT the final diagnosis.

Clinical discussion

Of the 116 patients included in our analysis, 56.9% (n=66) were females and age group was between 41 and 64 years old in 63.8% (n=74) of the patients. About 55 cases (47.4%) had abdominal or epigastric pain or discomfort, which was the most frequent clinical symptom. In immunohistochemistry, SMA staining is present in 68.1% of the cases, underscoring its diagnostic significance. Laparotomy with wedge or partial gastrectomy was employed in 46.1% of the recorded cases. Due to malignant potential, long-term follow-up and monitoring are usually recommended.

Conclusion

Despite the rarity of GGT, they should be included in the differential diagnosis of gastric submucosal tumors, with immunohistochemistry studies playing a major role in the diagnosis. Furthermore, a comprehensive evaluation of the literature in the past 8 years was presented in a table.

A 65-Year-Old Man Presenting to the Emergency Department with Gastric Hemorrhage Caused by a Glomus Tumor

BACKGROUND Glomus tumor is a benign but rapidly growing mesenchymal tumor that is a rare in the gastrointestinal tract, can be locally invasive due to its rapid growth, and can result in perforation of a viscus. We report a 65-year-old man presenting as an emergency with gastric hemorrhage and gastric glomus tumor. CASE REPORT A 65-year-old man came to our hospital for a life-threatening upper digestive hemorrhage. The preoperative examinations (digestive endoscopy without sampling of biopsy fragments and contrast-enhanced computer tomography) led to the presumptive diagnosis of gastrointestinal stromal tumor. Wedge resection of the gastric wall was performed. The histopathological examinations revealed a proliferation of round-oval cells of medium size with a solid disposition and in nests. This proliferation dissected the muscular tunic and caused ulceration of the gastric mucosa. Immunohistochemical tests confirmed the diagnosis of glomus tumor and excluded other diagnoses (neuroendocrine tumor or gastrointestinal stromal tumor). The postoperative evolution was favorable, and at the time of discharge, the biochemical test values normalized. CONCLUSIONS Pathologists are faced with a challenging task due to the deceptive appearance that can be presented by such a rare tumor. Histopathological and immunohistochemical examinations are essential in achieving a precise diagnosis and assessing the biological potential of the glomus tumor. Even if it is a benign tumor, the clinical picture it causes can still be a major risk to the patient's life. Consequently, ensuring effective case management becomes crucial, as it requires a thorough comprehension of all conditions encompassed in the differential diagnosis.

Gastric glomus tumor on EUS-FNA-based cytology: clinicopathologic and immunohistochemical features of 4 cases, including 1 case with associated MIR143HG-NOTCH2 fusion gene

INTRODUCTION

Gastric glomus tumor (GT) is a rare submucosal tumor for which the preoperative diagnosis can be challenging. We report the cytomorphologic and immunohistochemical features of 4 gastric GTs diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology.

MATERIALS AND METHODS

Files were searched to identify gastric GTs diagnosed by EUS-FNA between 2018 and 2021. A total of 4 cases of gastric GTs (3 men and 1 women; mean age, 60 years) were included.

RESULTS

Three GTs were located in the gastric antrum and one in the gastric body. Their size ranged from 2 to 2.5 cm. Three patients presented with epigastric discomfort and one with chest wall discomfort. Rapid on-site evaluation was performed for 3 cases; the findings for all 3 were indeterminate. The smears were moderate to highly cellular and showed loose clusters of evenly distributed small- to medium-size bland tumor cells. The tumor cells had centrally located round to oval nuclei with inconspicuous nucleoli and scant to moderate amount of eosinophilic to clear cytoplasm. Examination of the cell blocks revealed branching small vessels surrounded by small- to medium-size cells. The neoplastic cells were positive for smooth muscle actin and synaptophysin and negative for AE1/AE3 and S-100. C-KIT and CD34 were variably positive. Ki-67 was <2% positive. In 1 case, the fusion panel-solid tumor (50 genes) revealed the MIR143HG-NOTCH2 fusion gene.

CONCLUSIONS

Smears and cell block preparation revealed angiocentric sheets of uniform, small round to oval tumor cells with pale to eosinophilic cytoplasm, intermingled with endothelial cells. The differential diagnosis of gastric GTs on rapid on-site evaluation includes neuroendocrine tumors and epithelioid or spindled cell neoplasms. Immunohistochemical and molecular studies can be helpful in the preoperative diagnosis of gastric GT.

A Rare Gastric Subepithelial Lesion Removed through Submucosal Tunneling Endoscopic Resection: Case Report and Literature Review

Gastric subepithelial lesions are common. However, their diagnosis and management can pose a challenge. Herein, we present the case of a 49-year-old man who was incidentally discovered to have a gastric subepithelial lesion that increased in size during follow-up. Submucosal tunneling endoscopic resection was performed, and the tumor was successfully removed en bloc. The pathological and immunohistochemical findings were consistent with a gastric globus tumor. Although rare, glomus tumors should be considered when gastric subepithelial lesions are discovered. Resection with an endoscopic technique can be used to preserve the stomach and can be considered an alternative to surgical removal. However, such procedures should only be performed by experienced therapeutic endoscopists.

Gastric glomus tumor resection using laparoscopic endoscopic cooperative surgery: A case report

Gastric glomus tumors are rare submucosal mesenchymal neoplasms that are difficult to diagnose preoperatively. We present a case of a 60-year-old woman who was diagnosed with a gastric glomus tumor using endoscopic ultrasonography-guided fine-needle aspiration biopsy. The tumor was successfully resected with laparoscopic endoscopic cooperative surgery (LECS). LECS could be an effective method for the resection of gastric glomus tumors.

Gastric Glomus Tumor Diagnosed by Upper Endoscopy

Gastric glomus tumors (GGTs) are benign tumors that typically occur in the submucosa of the gastric wall. Glomus tumors typically occur in the subungual region of the finger and rarely manifest in the stomach. Diagnosis is challenging as these tumors lack specific clinical features, radiographic findings, and endoscopic findings. In prior cases, endoscopic ultrasound with fine-needle aspiration has been utilized to make a pre-operative diagnosis. In our case, pathology from general endoscopy was consistent with a GGT. Thus, our patient was accurately diagnosed by esophagogastroduodenoscopy (EGD) with conventional biopsy.

Gastric glomus tumor diagnosed by fine needle aspiration of the stomach: A report of two cases and review of the literature

Glomus tumors make up 1% of stromal tumors of the stomach. Radiologic diagnosis of glomus tumors can be challenging as they share imaging characteristics with other neuroendocrine tumors and gastrointestinal stromal tumors. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been reported as a useful method for the evaluation of gastrointestinal lesions. We report two cases of gastric glomus tumors in which EUS-FNA diagnosis was challenging. Cytologically, neoplastic cells were round to oval, uniform, bland appearing epithelioid cells with delicate chromatin and inconspicuous to vague nucleoli. Both samples lacked worrisome features such as high nuclear grade, high mitotic rate, and necrosis. Neoplastic cells were negative for Cam5.2 and AE1/AE3 with focal expression of synaptophysin in one of the cases. A definitive diagnosis was not made based on FNA. Familiarity with glomus tumors in the GI system and procurement of adequate material for cell block allowing the use of immunohistochemistry may allow an accurate preoperative diagnosis.