Gastric glomus tumor: a hypervascular submucosal tumor on power Doppler endosonography

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

Background and Objectives

Preoperative 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.

Methods

A 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.

Results

Eleven 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.

Conclusions

Gastric 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.

Sonographic diagnosis of a glomus tumor of the thigh

Extradigital glomus tumors are a very rare entity. Here, we report a rare case of a glomus tumor in an atypical anatomic site: the thigh. The clinical features together with the results of MRI, and sonography and Doppler sonographic imaging helped to distinguish glomus tumor of the thigh from other soft tissue neoplasms. The tumor arising from the thigh was excised, and following surgery, the patient was symptom free without evidence of complications or recurrence. There have only been a few previously reported cases describing the use of Doppler sonography in the evaluation of extradigital glomus tumors. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:50-52, 2017.

What kind of a gastric tumor is this?

This case report describes a gastric small submucosal tumor endosonographically resembling a gastrointestinal stromal tumor (GIST). The presence of calcifications inside prompted for the surgical excision, and the pathologic examination revealed in fact the presence of a glomangioma (glomus tumor). The presented case is an illustration of the fact that not all masses arising from the muscularis propria layer are GISTs, and the endosonographer must always think of alternative diagnoses.

Computed tomography and clinical characteristics of gastric glomus tumors

OBJECTIVE

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Glomus tumor in the stomach: A case report and review of the literature

This study reports a rare case of a 47-year-old female with a gastric glomus tumor who was admitted with epigastralgia. Endoscopic ultrasound revealed a protrusion on the posterior wall of the gastric antrum. Enhanced computed tomography confirmed the presence of a 10-mm mass. The tumor was resected, and immunohistochemistry revealed the tumor to be positive for smooth muscle actin and collagen type IV, and negative for synaptophysin, chromogranin A, laminin, S-100, cluster of differentiation (CD)34, CD31, CD99, cytokeratin (AE1/AE3), desmin and epithelial membrane antigen. The proliferation marker Ki-67 was positive in <5% of tumor cell nuclei. The clinical procedures with a review of the literature are reported.

Unusual motion detected on real-time sonography inside a glomus tumor in the thigh

Glomus tumors are rare and many have been reported to have a hypervascular appearance on color or power Doppler sonography. We report a pathologically proven case of superficial glomus tumor within the thigh with no detectable color flow signals on color or power Doppler sonography. In addition, real-time sonography showed spontaneous motions within the tumor, which were not synchronized with vascular or respiratory motions, and misled the presurgical diagnosis of a suspected parasite in a patient who had direct contact with multiple animal species. The etiology of this internal motion remains hypothetical but, if reconfirmed, this finding may be a useful adjunctive sign for the diagnosis of glomus tumors.

Gastric glomus tumor: analysis of endosonographic characteristics and computed tomographic findings

Among submucosal tumors (SMT), gastric glomus tumors are rare vascular tumors, and only a few cases where glomus tumors have been differentiated from other mesenchymal tumors by endoscopic ultrasonography (EUS) or computed tomography (CT) have been reported. In this case series, we aimed to analyze the EUS and CT characteristics of gastric glomus tumors. Seven patients with gastric glomus tumors were retrospectively enrolled in this study. EUS showed that all the tumors were located in the fourth EUS layer (muscularis propria) and had distinct borders. The tumors had a heterogeneous appearance with either hypo- or hyperechogenicity, and all the tumors except one had the characteristic peripheral halo around them. On CT scans,all the tumors appeared as well-defined SMT with a clear margin and showed the same characteristics in the different phases of CT. During dynamic contrast-enhanced CT, the tumors showed strong enhancement in the arterial phase and prolonged enhancement in the delayed phase. This case series shows the characteristic EUS findings and the distinguishing features of CT scans for gastric glomus tumors; these findings will help in differentiating gastric glomus tumors from other SMT.

Glomus tumour of the stomach: an unusual cause of gastrointestinal bleeding

Glomus tumours are a rare type of subepithelial mesenchymal tumours that present in deep visceral organs such as the stomach, which are difficult to diagnose. We report a case of a 44-year-old woman with diabetes who presented with anaemia, abdominal pain and melena diagnosed preoperatively with a gastric glomus tumour initially misdiagnosed as a gastric ulcer located at the lesser curvature. Upon referral to our centre a repeat endoscopy and biopsy were performed. A partial gastrectomy was performed with no complications. Histopathological analysis of the tumour reported clear margins and immunostaining was positive for smooth muscle actin and collagen IV. The patient remains asymptomatic at 3-month follow-up.

Small submucosal tumors of the stomach: differentiation of gastric schwannoma from gastrointestinal stromal tumor with CT

Objective

To identify the CT features that help differentiate gastric schwannomas (GS) from small (5 cm or smaller) gastrointestinal stromal tumors (GIST) and to assess the growth rates of both tumors.

Materials and Methods

We included 16 small GSs and 56 GISTs located in the stomach. We evaluated the CT features including size, contour, surface pattern, margins, growth pattern, pattern and degree of contrast enhancement, and the presence of intralesional low attenuation area, hemorrhage, calcification, surface dimpling, fistula, perilesional lymph nodes (LNs), invasion to other organs, metastasis, ascites, and peritoneal seeding. We also estimated the tumor volume doubling time.

Results

Compared with GISTs, GSs more frequently demonstrated a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs (each p < 0.05). The intralesional low attenuation area was more common in GISTs than GSs (p < 0.05). Multivariate analyses indicated that a homogeneous enhancement pattern, exophytic or mixed growth pattern, and the presence of perilesional LNs were statistically significant (p < 0.05). Tumor volume doubling times for GSs (mean, 1685.4 days) were significantly longer than that of GISTs (mean, 377.6 days) (p = 0.004).

Conclusion

Although small GSs and GISTs show similar imaging findings, GSs more frequently show an exophytic or mixed growth pattern, homogeneous enhancement pattern, perilesional LNs and grow slower than GISTs.

Selected unusual tumors of the stomach: a review

Several unusual stomach tumors have been recently described. In addition, some tumors that are often encountered in other sites may rarely occur as primary gastric tumors. The diagnostic surgical pathologist needs to be aware of some of these lesions to prevent misdiagnosis. This overview discusses the key clinical features, pathology, immunohistochemistry, and relevant molecular findings of multiple minute gastrointestinal stromal tumors and interstitial cell of Cajal hyperplasia, nerve sheath tumors (schwannoma and perineurioma), gastroblastoma, granular cell tumor, glomus tumor, plexiform angiomyxoid myofibroblastic tumor, and primary clear cell sarcoma of the gastrointestinal tract that occur as primary gastric neoplasms.

Glomus tumor of the stomach: a rare cause of upper gastrointestinal bleeding

Introduction. Glomus tumors (GTs) are benign neoplasm originating from the glomus body, commonly described in subungual region. The involvement abdominal is rare. Our aim is to describe a case of glomus tumor of the stomach that presented upper gastrointestinal bleeding. A 34-year-old woman was admitted with upper gastrointestinal bleeding and underwent an upper endoscopy that showed bleeding arising from an ulcerated lesion, treated by sclerosis therapy. A new endoscopy confirmed a submucosal lesion in upper portion of the stomach. During the laparotomy, a tumor at the upper anterior wall of gastric body was found and resected by a vertical gastrectomy. The pathological exam revealed hyperplastic smooth muscle fibers of the muscularis propria of the stomach wall, surrounded by hyaline stroma. The immunohistochemistry panel was positive for smooth muscle actin and type IV collagen, with low rate of mitosis studied by Ki-67 which allowed the final diagnosis of a gastric glomus tumor. Discussion. The majority of intraperitoneal glomus tumors occur in the stomach, and it is phenotypically similar to those localized in peripheral sites. Gastric GT generally is a benign tumor although it can be malignant and have the potential to metastasize. Conclusion. Even though gastric glomus tumor is rarely described, it should be considered as a possible cause of a major upper gastrointestinal bleeding.

Endoscopic diagnosis and treatment of gastric glomus tumors

BACKGROUND

Although gastric glomus tumors are usually benign lesions, occasional malignant transformation has been reported. Thus, complete resection of the gastric glomus tumor is necessary.

OBJECTIVE

To provide a better understanding of the endoscopic features of this rare entity with an emphasis on its diagnosis and treatment.

DESIGN

Retrospective case series.

SETTING

Academic medical center.

PATIENTS

Six patients (2 men, 4 women; median age 48 years) received a diagnosis of gastric glomus tumor and were treated.

INTERVENTIONS

Endoscopic diagnosis and resection.

MAIN OUTCOME MEASUREMENTS

Endoscopic features, resection success, adverse events, and follow-up endoscopy.

RESULTS

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).

LIMITATIONS

Small number of patients (N=6), limited follow-up, retrospective study.

CONCLUSIONS

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.

Clinicopathological features of gastric glomus tumor

AIM: To study the clinicopathological features of gastric glomus tumor and review the related Chinese literature published in 1990-2010.

METHODS: A case of gastric glomus tumor was reported. Clinicopathological findings in 56 cases of gastric glomus tumor were analyzed.

RESULTS: Gastric glomus tumor was far more common in women than in men with a female to male ratio of 1.6:1. The median age of the patients was 45 years (range 28-79 years). The patients often complained of epigastric pain and bloody stool. The tumor was located in antrum of the stomach. The greatest diameter of the tumor was 0.8-11cm. Histologically, the tumor was comprised of nests of glomus cells surrounding the capillaries. Glomus cells were small, uniform and round. Vimentin, smooth muscle actin and actin were expressed in the tumor. Other markers, including S-100 protein, CD34, CD117, desmin, CD56, synaptophysin, chromogranin A, neuron specific enolase and cytokeratin were all negative.

CONCLUSION: Gastric glomus tumor is a rare benign mesenchymal neoplasm. Its diagnosis depends on pathologic examination. Differential diagnosis includes gastrointestinal stromal tumor, paraganglioma and carcinoid tumor.

Gastric glomus tumor: a case report

Gastric glomus tumors are rare mesenchymal tumors of the gastrointestinal tract. We describe a 72-year-old patient who presented with episodes of melena and was subsequently investigated for a tumor of the antrum of the stomach. Surgical resection revealed a 2 x 2 x 1.7 cm well circumscribed submucosal tumor, extending into the muscularis propria. The histopathologic examination of the specimen demonstrated a glomus tumor of the stomach. We discuss the preoperative investigation, the diagnostic problems and the surgical treatment of the patient with this rare submucosal lesion.