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A Rare Gastric Subepithelial Lesion Removed through Submucosal Tunneling Endoscopic Resection: Case Report and Literature Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010179. [PMID: 36676128 PMCID: PMC9864563 DOI: 10.3390/life13010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Abstract
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.
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Mohamed WT, Jahagirdar V, Jaber F, Ahmed M, Fatima I, Chhabra R, Tawfik O. Glomus Tumor of the Stomach Presenting With Upper Gastrointestinal Bleeding: A Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231192891. [PMID: 37565695 PMCID: PMC10422895 DOI: 10.1177/23247096231192891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
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.
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Ezeh KJ, Rajwana Y, Paudel B, Shen T, Botros Y. Gastric Glomus Tumor Presenting With Gastrointestinal Bleed and Pulmonary Embolism: A Rare Entity With Management Dilemma. Cureus 2022; 14:e25632. [PMID: 35795510 PMCID: PMC9250802 DOI: 10.7759/cureus.25632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/05/2022] Open
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Mehmood F, Jamil H, Khalid A. Gastric Glomus Tumor: A Rare Cause of Acute Blood Loss Anemia. Cureus 2022; 14:e24511. [PMID: 35651378 PMCID: PMC9135585 DOI: 10.7759/cureus.24511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/09/2023] Open
Abstract
Gastric glomus tumors (GGTs) are rare mesenchymal neoplasms that arise from cells of the glomus body. These occur in the submucosa of the gastric wall and are usually benign in nature. However, it is difficult to predict tumor behavior due to the lack of reliable histological features. Diagnosis can be challenging due to the lack of specific clinical features, and radiologic and endoscopic findings. Computed tomography (CT) scan, esophagogastroduodenoscopy (EGD), and endoscopic ultrasound (EUS) are key diagnostic modalities. However, the final diagnosis depends on the postoperative immunohistochemical and pathological analysis. Most GGTs can be cured by surgical or endoscopic resection. We report a case of GGT in a middle-aged woman who presented with new-onset anemia and was found to have a gastric mass that was later diagnosed as GGT after immunohistochemical staining.
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Tsagkataki ES, Flamourakis ME, Gkionis IG, Giakoumakis MI, Delimpaltadakis GN, Kazamias GM, Giannikaki ES, Christodoulakis MS. Gastric glomus tumor: a case report and review of the literature. J Med Case Rep 2021; 15:415. [PMID: 34392835 PMCID: PMC8365960 DOI: 10.1186/s13256-021-03011-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Gastric 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 presentation We 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. Discussion Preoperative 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. Conclusion The 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.
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Affiliation(s)
- Eleni S Tsagkataki
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece
| | - Mathaios E Flamourakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece
| | - Ioannis G Gkionis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece.
| | - Michail I Giakoumakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece
| | - Georgios N Delimpaltadakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece
| | - Georgios M Kazamias
- Department of Pathology, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Elpida S Giannikaki
- Department of Pathology, Venizeleio General Hospital, Leoforos Knossou 44, Heraklion, Crete, Greece
| | - Manousos S Christodoulakis
- Department of General Surgery, Venizeleio General Hospital, Leoforos Knossou 44, 71409, Heraklion, Crete, Greece
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6
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[Gastric glomus tumors. Interest of ultrasound endoscopic biopsies for the diagnosis. About two cases]. Ann Pathol 2021; 41:476-480. [PMID: 34376296 DOI: 10.1016/j.annpat.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
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).
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Mendo R, Barosa R, Pinto Marques P, Albuquerque C, Santos C. An Unusual Gastric Subepithelial Lesion: Expect the Not so Expectable. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 29:68-70. [DOI: 10.1159/000515467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
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8
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Wang X, Hanif S, Wang B, Chai C. Management of gastric glomus tumor: A case report. Medicine (Baltimore) 2019; 98:e16980. [PMID: 31567933 PMCID: PMC6756591 DOI: 10.1097/md.0000000000016980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/28/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Gastric glomus tumor (GGT) is a rare gastrointestinal tumor and its preoperative imaging features are significant to make a correct diagnosis, while the assessment of the pathological and immunohistochemical characteristics of the specimen are the main methods used for its diagnosis. This study introduces the clinical uniqueness, endoscopic ultrasonography, radiology, histology and immunohistochemistry results of a patient with GGT to discuss the imaging and clinico-pathological features, diagnosis and differential diagnosis of GGT. PATIENT CONCERNS The patient expressed a complaint concerning an "intermittent abdominal pain for 4 months". DIAGNOSES The patient was diagnosed with gastric stromal tumor according to the clinical manifestations and imaging examination before the operation. The pathological examination of an intra-operative frozen sample confirmed the benign nature of the tumor, while post-operative immunohistochemistry results indicate the presence of a GGT. The postoperative histology revealed a tumor tissue composed of irregular blood vessels and glomus cells of same size with interstitial hyaline and mucoid degeneration. Immunohistochemical staining showed positivity for SMA (+), vimentin (3+), CD 34 (vascular +), and Factor VIII (vascular +). INTERVENTIONS The tumor was completely removed by surgery. OUTCOMES The patient recovered well, and was discharged from the hospital. Five months after the operation, a normal gastric mucosa was observed by gastroscopic examination. LESSONS Most of the GGTs are benign lesions, surgical resection is the preferred treatment and they result in a good prognosis. However, malignant GGT should be treated as soon as possible because of its metastatic potential and recurrence. Adjuvant radiotherapy or chemotherapy might be useful after operation.
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Affiliation(s)
- Xingcheng Wang
- Department of General Surgery, Xian Children's Hospital, Xian, Shanxi
| | - Shahbaz Hanif
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu
| | - Binsheng Wang
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu
| | - Chen Chai
- Department of General Surgery, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, China
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Namikawa T, Tsuda S, Fujisawa K, Iwabu J, Uemura S, Tsujii S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Glomus tumor of the stomach treated by laparoscopic distal gastrectomy: A case report. Oncol Lett 2018; 17:514-517. [PMID: 30655795 DOI: 10.3892/ol.2018.9621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Sachi Tsuda
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kazune Fujisawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Shigehiro Tsujii
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Kochi 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Kochi 783-8505, Japan.,Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Nankoku, Kochi 783-8505, Japan
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Rosales-López E, Salceda-Otero J, Angulo-Molina D, Posada-Torres J, Canchola-Aguilar M, Lozoya-Gonzalez D. Gastric glomangioma, differential diagnosis of gastrointestinal stromal tumors. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2018. [DOI: 10.1016/j.rgmxen.2017.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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11
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Rosales-López E, Salceda-Otero JC, Angulo-Molina D, Posada-Torres JA, Canchola-Aguilar MG, Lozoya-Gonzalez D. Gastric glomangioma, differential diagnosis of gastrointestinal stromal tumors. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2018; 83:72-74. [PMID: 28392052 DOI: 10.1016/j.rgmx.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 06/07/2023]
Affiliation(s)
- E Rosales-López
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
| | - J C Salceda-Otero
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México; Ultrasonido Endoscópico, Centro Médico ABC, Ciudad de México, México.
| | - D Angulo-Molina
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
| | | | | | - D Lozoya-Gonzalez
- Servicio de Endoscopía Gastrointestinal, Centro Médico ABC, Ciudad de México, México
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Zhang Y, Wang Z, Jin T, Li KQ, Hao K, Zhang W, Fei BY. Hyperechoic demarcation line between a tumor and the muscularis propria layer as a marker for deciding the endoscopic treatment of gastric submucosal tumor. J Zhejiang Univ Sci B 2017; 18:707-716. [PMID: 28786245 DOI: 10.1631/jzus.b1600256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Minimally invasive endoscopic resection has been rapidly adopted as a new technique for treating patients with gastric submucosal tumors (SMTs) originating in the muscularis propria (MP) layer. This study was conducted to evaluate the information obtained from endoscopic ultrasonography (EUS) to determine the appropriate endoscopic dissection method for treating SMTs originating in the MP layer. Between February 2014 and May 2016, a total of 50 patients with gastric SMTs originating in the MP layer were enrolled in this study. The clinical features of the patients and their endoscopic, EUS, and histopathologic findings, as well as their postoperative follow-up data, were analyzed in this retrospective study. The mean age of the patients was (55.0±10.2) years, and the male/female ratio was 17:33. Endoscopic submucosal dissection (ESD) was performed on 43 patients and an endoscopic full-thickness resection (EFR) was performed on seven patients. The most frequent location for an SMT was in the upper body region of the stomach (n=16), and the most common pathological diagnosis was a gastrointestinal stromal tumor (GIST) (n=32). The overall rates for complete resection were 95.3% (41/43) and 100.0% (7/7) when the SMTs were treated by ESD and EFR, respectively. The presence of a complete tumor capsule was significantly associated with a complete resection (P=0.001). Of the cases treated by ESD, nine patients developed perforation, one of whom required laparoscopic surgery. The remaining patients were closed with clips or purse-string sutures. The presence of an MP2-type tumor (P=0.018) and a wide connection with the MP layer (P=0.044) were significantly associated with perforation. A preoperative evaluation of the integrity and the location of a tumor capsule and the length of the tumor connection with the MP layer by EUS can improve the complete resection rate and reduce the occurrence of intraoperative complications. Tumors with a complete capsule originating from the superficial MP layer or with a narrow connection with the MP layer are appropriate candidates for treatment by ESD.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Zhen Wang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Ting Jin
- Department of Gastroenterology, the First People's Hospital of Xiaoshan District, Hangzhou 311200, China
| | - Kai-Qiang Li
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Ke Hao
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Wei Zhang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Bao-Ying Fei
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
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13
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Lin YM, Chiu NC, Li AFY, Liu CA, Chou YH, Chiou YY. Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review. World J Gastroenterol 2017; 23:2493-2504. [PMID: 28465633 PMCID: PMC5394512 DOI: 10.3748/wjg.v23.i14.2493] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/25/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography (MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign (glomus tumors, schwannomas, leiomyomas, and lipomas), malignant (gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions (ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.
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Shi L, Zhao W, Zhou Y, Zhu HH, Wang H, Chen P. Therapeutic value of endoscopic submucosal dissection for gastric muscularis propria tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:4706-4712. [DOI: 10.11569/wcjd.v23.i29.4706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for tumors originating from the gastric muscularis propria.
METHODS: Forty-two patients with tumors originating from the gastric muscularis propria who underwent endoscopic therapy between January 2013 and January 2015 were included. The complications, clinicopathological data, and postoperative follow-up data were analyzed.
RESULTS: Of the 42 patients, 20 were managed by ESD, 15 by endoscopic submucosal excavation (ESE), and 7 by endoscopic full-thickness resection (EFR). Four cases underwent surgery for unsuccessful endoscopic resection, including three cases receiving laparoscopic surgery for difficulties in en bloc removal or perforation, and 1 case receiving open surgery because of uncontrolled bleeding, and the success rate was 90.48%. Delayed hemorrhage occurred in two patients and no delayed perforation occurred. All the complications were successfully managed by endoscopic intervention and conservational therapy. Seven cases of active perforation in the EFR group were all successfully managed by endoscopy. The post-operative follow-up period ranged from 6 to 28 mo. No local recurrence or distant metastasis occurred.
CONCLUSION: ESD is an effective procedure for tumors originating from the gastric muscularis propria, and laparoseopic intervention is necessary for en bloc resection in some cases.
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15
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Zhang Y, Ye LP, Mao XL. Endoscopic treatments for small gastric subepithelial tumors originating from muscularis propria layer. World J Gastroenterol 2015; 21:9503-9511. [PMID: 26327758 PMCID: PMC4548111 DOI: 10.3748/wjg.v21.i32.9503] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/15/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive endoscopic resection has become an increasingly popular method for patients with small (less than 3.5 cm in diameter) gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. Currently, the main endoscopic therapies for patients with such tumors are endoscopic muscularis excavation, endoscopic full-thickness resection, and submucosal tunneling endoscopic resection. Although these endoscopic techniques can be used for complete resection of the tumor and provide an accurate pathological diagnosis, these techniques have been associated with several negative events, such as incomplete resection, perforation, and bleeding. This review provides detailed information on the technical details, likely treatment outcomes, and complications associated with each endoscopic method for treating/removing small gastric SETs that originate from the MP layer.
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16
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Rimbaş M, Micu G. What kind of a gastric tumor is this? CURRENT HEALTH SCIENCES JOURNAL 2015; 41:70-72. [PMID: 30151253 PMCID: PMC6057530 DOI: 10.12865/chsj.41.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- M Rimbaş
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania, Internal Medicine Department, Carol Davila University of Medicine, Bucharest, Romania
| | - G Micu
- Pathology Department, Colentina Clinical Hospital, Bucharest, Romania
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17
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Chen KB, Chen L. Glomus tumor in the stomach: A case report and review of the literature. Oncol Lett 2014; 7:1790-1792. [PMID: 24932234 PMCID: PMC4049669 DOI: 10.3892/ol.2014.1986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 02/18/2014] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Kai-Bo Chen
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Li Chen
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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18
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Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer: results from a large study in China. J Clin Gastroenterol 2013; 47:689-94. [PMID: 23632361 DOI: 10.1097/mcg.0b013e3182908295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM In this retrospective study, we investigated the safety and efficacy of endoscopic excavation of gastric subepithelial tumors (SETs) originating from the muscularis propria (MP) layer. MATERIALS AND METHODS Between November 2007 and June 2012, 212 patients with gastric SETs originating from the MP layer were treated via endoscopic excavation. The key procedures were: (1) injecting a mixture solution (100 mL saline+2 mL indigo carmine+1 mL epinephrine) into the submucosa around the tumor; (2) making a cross-incision of the mucosa and then excavating the tumor by the technique of endoscopic excavation. After the tumor was completely excavated from the MP layer, it was removed using a snare; (3) closing the artificial ulcer with clips. RESULTS The mean diameter of the 212 tumors was 16.5 mm. Complete resection by endoscopic excavation was achieved in 204 cases (96.2%). The rate of complete resection was significantly higher for tumors <2 cm (98.0%) than for tumors >2 cm (91.9%) (P=0.035). Perforation occurred in 32 cases (15.1%), and massive bleeding occurred in 9 cases (4.2%) during the procedure. The rate of perforation was significantly higher for the fundus and the body than for antrum (21.5%, 11.5%, 0%, respectively; P=0.036), and also differed significantly in relation to histologic diagnosis (23.7% for gastrointestinal stromal tumors vs. 7.8% for leiomyoma; P=0.001). Histologic diagnosis showed that the density of gastrointestinal stromal tumors located in the fundus and the body of the stomach was significantly higher than in the antrum (44.1%, 51.9%, 13.3%, respectively; P=0.036). CONCLUSIONS Endoscopic excavation is a safe and efficient method for resecting small (>3.5 cm) gastric SETs originating from the MP layer.
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Li QL, Yao LQ, Zhou PH, Xu MD, Chen SY, Zhong YS, Zhang YQ, Chen WF, Ma LL, Qin WZ. Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video). Gastrointest Endosc 2012; 75:1153-8. [PMID: 22459663 DOI: 10.1016/j.gie.2012.01.037] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 01/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Given the high morbidity and mortality rates for surgery and the diminishment of quality of life caused by operative resection of the gastric cardia, a minor invasive treatment without loss of curability is desirable for submucosal tumors (SMTs) of the esophagogastric junction (EGJ). Endoscopic submucosal dissection (ESD) has been used successfully for the removal of esophageal or gastric SMTs; however, the EGJ has been regarded as a difficult location for ESD because of its narrow lumen and sharp angle. OBJECTIVE To evaluate the clinical impact of ESD for SMTs of the EGJ arising from the muscularis propria layer. DESIGN Single-center, prospective study. SETTING Academic medical center. PATIENTS 143 patients with 143 SMTs of the EGJ originating from the muscularis propria layer. INTERVENTIONS ESD. MAIN OUTCOME MEASUREMENTS Complications, en bloc resection rate, local recurrence, and distant metastases. RESULTS The average maximum diameter of the lesions was 17.6 mm (range 5 - 50 mm). The en bloc resection rate was 94.4% (135/143). All en bloc resection lesions showed both lateral and deep tumor-free margins, including 20 GI stromal tumors. Perforations occurred in 6 patients (4.2%, 6/143), and metal clips were used to occlude the defect. Four pneumoperitoneum and 2 pneumothorax caused by perforations were resolved with nonsurgical treatment. Local recurrence and distant metastasis have not occurred during a 2-year follow-up. LIMITATIONS Single-center, short follow-up. CONCLUSIONS ESD appears to be a safe, feasible, and effective procedure for providing accurate histopathologic evaluations, as well as curative treatments for SMTs of the EGJ originating from the muscularis propria layer.
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Affiliation(s)
- Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Nguyen NT, Shapiro C, Massomi H, Laugenour K, Elliott C, Stamos MJ. Laparoscopic enucleation or wedge resection of benign gastric pathology: analysis of 44 consecutive cases. Am Surg 2012. [PMID: 22127096 DOI: 10.1177/000313481107701027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Laparoscopic resection of gastric submucosal tumors has been described, but the role of laparoscopy for tumors within the esophagus or near the gastroesophageal junction is not clearly defined. The aim of this study was to examine the outcomes of laparoscopic or thoracoscopic enucleation or wedge resection of benign gastric tumors. The charts of 44 patients who underwent minimally invasive resection of benign esophagogastric tumors were reviewed. Surgical approaches included thoracoscopic enucleation (n = 2), laparoscopic enucleation (n = 6), transgastric enucleation (n = 2), and laparoscopic gastric wedge resection (n = 34). There were 23 males with a mean age of 57 years. There was one conversion (2.5%) to laparotomy. Mean operative time was 97 ± 52 minutes. The mean length of hospital stay was 2.6 ± 2.0 days. One patient developed gastric outlet obstruction requiring Roux-en-Y reconstruction. There were no leaks and the 90-day mortality was zero. Pathology demonstrated gastrointestinal stromal tumor (n = 31), leiomyoma (n = 6), and other benign pathology (n = 7). There has been one tumor recurrence at a mean follow-up of 4.3 years. The laparoscopic approaches to local resection of gastric tumors are safe and feasible. The type of minimally invasive surgical approaches should be tailored based on the location and size of the lesion.
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Affiliation(s)
- Ninh T Nguyen
- Department of Surgery, University of California, Irvine Medical Center, Orange, California 92868, USA.
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Glomus tumor of the stomach: a rare cause of upper gastrointestinal bleeding. Case Rep Surg 2011; 2011:371082. [PMID: 22606576 PMCID: PMC3350055 DOI: 10.1155/2011/371082] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/21/2011] [Indexed: 11/17/2022] Open
Abstract
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.
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