Computed tomography features and clinicopathological characteristics of gastric glomus tumor

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.

Imaging findings of gastric glomus tumors

Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0 cm vs. 5.3 cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5 cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy.

Case report: One case of precise resection of gastric glomus tumor by gastroscopy combined with laparoscopy

Introduction

Gastric glomus tumor is a rare submucosal mesenchymal tumor with no distinct features on endoscopy. In clinical practice, it is often treated with laparoscopic partial gastrectomy. Here, we report a case of gastric glomus tumor successfully resected using a combination of gastroscopy and laparoscopy.

Case description

The patient was an elderly male who underwent gastroscopy, which revealed a submucosal mass in the gastric antrum. The lesion was suspected to be a stromal tumor. Further evaluation with computed tomography (CT) imaging indicated a space-occupying lesion in the gastric antrum, with the possibility of benign pathology. Endoscopic ultrasonography revealed that the tumor originated from the muscular layer and was approximately 28.8 mm ×22.5 mm. Blood flow was detected behind the lesion, suggesting the possibility of a gastric glomus tumor. The tumor was removed using a combination of gastroscopy and laparoscopy. Postoperative pathology suggested that it was a benign gastric glomus tumor. The patient recovered uneventfully and was discharged 7 days later.

Conclusion

Gastric glomus tumor is a rare submucosal tumor that should be included in the differential diagnosis of gastric submucosal tumors. A combined approach using gastroscopy and laparoscopy offers a minimally invasive and effective treatment option.

A case of malignant gastric glomus tumor and literature review: A case report

RATIONALE

Malignant gastric glomus tumor (GGT) is an extremely rare malignant tumor of mesenchymal origin, it affects the patient's health and even threatens life. Malignant GGT with vascular invasion is even more rarely reported in the available literature without a prognostic study. So, in this case, we report a malignant GGT with vascular invasion and performed a 5-year postoperative follow-up. To the best of our knowledge, we report the first case of malignant GGT with vascular invasion without recurrence 5 years after surgery. This provides examples and lessons for the treatment of malignant GGT with vascular invasion.

PATIENT CONCERNS

A 49-year-old male was admitted to the hospital with gallbladder stones found on health check. After completing abdominal CT and ultrasound gastroscopy, a mass in the gastric antrum was found.

DIAGNOSES

The diagnosis of malignant GGT was confirmed by combination of postoperative pathology with positive immunohistochemistry for SMA, vimentin, synaptophysin, H-caldesmon, and calponin, mitosis > 10/50 HPF and moderate-to-severe nuclear atypia.

INTERVENTIONS

On the 6th day of hospitalization, the patient underwent laparoscopic distal gastrectomy and cholecystectomy.

OUTCOMES

The patient was discharged successfully 1 week after surgery and was followed up for 5 years without recurrence.

CONCLUSION

Malignant GGT can be asymptomatic. For malignant GGT without distant metastasis, despite the presence of vascular invasion, negative margin surgery can still be the standard surgical radical treatment.

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.

Computed tomographic imaging features to differentiate gastric schwannomas from gastrointestinal stromal tumours: a matched case-control study

To investigate clinical data and computed tomographic (CT) imaging features in differentiating gastric schwannomas (GSs) from gastric stromal tumours (GISTs) in matched patients, 31 patients with GSs were matched with 62 patients with GISTs (1:2) in sex, age, and tumour site. The clinical and imaging data were analysed. A significant (P < 0.05) difference was found in the tumour margin, enhancement pattern, growth pattern, and LD values between the 31 patients with GSs and 62 matched patients with GISTs. The GS lesions were mostly (93.5%) well defined while only 61.3% GIST lesions were well defined.The GS lesions were significantly (P = 0.036) smaller than the GIST lesions, with the LD ranging 1.5-7.4 (mean 3.67 cm) cm for the GSs and 1.0-15.30 (mean 5.09) cm for GIST lesions. The GS lesions were more significantly (P = 0.001) homogeneously enhanced (83.9% vs. 41.9%) than the GIST lesions. The GS lesions were mainly of the mixed growth pattern both within and outside the gastric wall (74.2% vs. 22.6%, P < 0.05) compared with that of GISTs. No metastasis or invasion of adjacent organs was present in any of the GS lesions, however, 1.6% of GISTs experienced metastasis and 3.2% of GISTs presented with invasion of adjacent organs. Heterogeneous enhancement and mixed growth pattern were two significant (P < 0.05) independent factors for distinguishing GS from GIST lesions. In conclusion: GS and GIST lesions may have significantly different features for differentiation in lesion margin, heterogeneous enhancement, mixed growth pattern, and longest lesion diameter, especially heterogeneous enhancement and mixed growth pattern.

Value of enhanced computed tomography in differentiating small mesenchymal tumours of the gastrointestinal from smooth muscle tumours

BACKGROUND

Computed tomography (CT) technology has been gradually used in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.

AIM

To explore the value of enhanced CT in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.

METHODS

Clinical data of patients with gastric mesenchymal or gastric smooth muscle tumours who were treated in our hospital from May 2018 to April 2023 were retrospectively analysed. Patients were divided into the gastric mesenchymal tumor group and the gastric smooth muscle tumor group respectively (n = 50 cases per group). Clinical data of 50 healthy volunteers who received physical examinations in our hospital during the same period were selected and included in the control group. Serum levels of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), CA-125 and cytokeratin 19 fragment antigen 21-1 were compared among the three groups. The value of CEA and CA19-9 in the identification of gastric mesenchymal tumours was analysed using the receiver operating characteristic (ROC) curve. The Kappa statistic was used to analyse the consistency of the combined CEA and CA19-9 test in identifying gastric mesenchymal tumours.

RESULTS

CEA levels varied among the three groups in the following order: The gastric mesenchymal tumour group > the control group > the gastric smooth muscle tumour group. CA19-9 levels varied among the three groups in the following order: The gastric mesenchymal group > the gastric smooth muscle group > the control group, the difference was statistically significant (P < 0.05). ROC analysis showed that the area under the curve of CEA and CA19-9 was 0. 879 and 0. 782, respectively.

CONCLUSION

Enhanced CT has shown value in differentiating small mesenchymal tumors of the stomach and intestines from smooth muscle tumors.

A case of mediastinal mesenchymal tumor with pericytic neoplasm feature that responded to radiation therapy

Here, we report a case of mediastinal mesenchymal tumor with a pericytic neoplasm feature that responded to radiation therapy. A 43-year-old man visited our hospital with a complaint of esophageal obstruction and chest pain. Chest computed tomography revealed a middle mediastinal tumor and a mesenchymal tumor was diagnosed with a pericytic neoplasm feature by video-assisted thoracoscopic biopsy. The definitive treatment for soft tissue tumor is surgical resection; however, the mediastinal tumor was unresectable because of esophageal and tracheal invasion. Radiation therapy was administered and there was a partial tumor response and 2 years disease-free status. With a review of the literature, we discuss the clinical and pathological characteristics of this rare tumor and its treatment.

Glomus Tumor of the Stomach Presenting With Upper Gastrointestinal Bleeding: A Case Report

Gastric glomus tumor is a rare mesenchymal tumor of the gastrointestinal tract, accounting for approximately 1% of all gastrointestinal soft tissue tumors. We describe a unique case of a 27-year-old female patient who presented with recurrent episodes of overt gastrointestinal bleeding requiring multiple blood transfusions. The patient was diagnosed with a gastric ulcer detected on esophagogastroduodenoscopy (EGD), which was grossly suggestive of an ulcerated gastrointestinal stromal tumor (GIST). Preoperative diagnosis was difficult, requiring laparoscopic robotic-assisted local wedge resection of the gastric mass. Pathological diagnosis and immunohistochemical (IHC) studies were consistent with a glomus tumor. We emphasize that the gastric glomus tumor might present with life-threatening recurrent gastrointestinal hemorrhage. In addition, it might mimic GIST and require surgical resection. Pathological diagnosis and IHC studies are needed to confirm the diagnosis.