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Xing JJ, Huang WP, Wang F, Chai YR, Gao JB. Computed tomography features and clinicopathological characteristics of gastric glomus tumor. BMC Gastroenterol 2022; 22:174. [PMID: 35397495 PMCID: PMC8994361 DOI: 10.1186/s12876-022-02241-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastric 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.
Methods
The 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).
Results
The 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.
Conclusions
CT 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.
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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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Alsahwan AG, Alfaraj ZM, AlSafwani J, Bunaiyan AH, AlKhalifah RH, Al-Saba'a SA, Al-Momen SA, Aldolah Q. Rare gastric neoplasm: Malignant glomus tumor of the stomach. A case report. Int J Surg Case Rep 2021; 81:105802. [PMID: 33887847 PMCID: PMC8045044 DOI: 10.1016/j.ijscr.2021.105802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Glomus tumors are rare neoplasms that aris-e from neuromyoarterial canal or glomus body. They are mainly found in the peripheral soft tissue, extremities and rarely developed inside the gastrointestinal tract. In the gastrointestinal tract, the stomach is the most common site for the development of glomus tumors, and most often found in the antrum. Usually, the symptoms of gastric glomus tumors are non specific i.e (abdominal pain, GI bleeding and/or perforation) and possibly discovered incidentally during upper GI endoscopy. CASE PRESENTATION This is a-56-year-old-male, presented to the emergency department with upper GI bleeding i.e (melena), and signs of shock (HR: 110; BP:80/60), Blood tests showed Hemoglobin level: 5 g/dl. Resuscitation was started with IV fluid and transfusion of 4 units of PRBCs. After resuscitation, He gave a 10 days history of passing black tarry stool, palpitation, headache, dizziness, easily fatigability, malaise, and colicky epigastric abdominal pain. His abdomen was soft, lax with no tenderness, there was fullness at the left upper quadrant. Upper GI endoscopy was performed that showed a large gastric ulcer with adherent clots, necrotic base and oozing at the proximal part of the greater curvature, after that the bleeding was managed with a heater probe and epinephrine injections. The histopathological examination of the biopsy revealed a spindle and epithelioid tumor with the top differential diagnosis being GIST, however other submucosal lesions cannot be excluded. After that, He underwent exploratory laparotomy and wedge resection of the tumor. The final histopathology showed a malignant glomus tumor. CLINICAL DISCUSSION Due to overlapping clinical and radiological features between glomus, GIST and other submucosal lesions, the histopathological examination is considered to be the gold standard for the diagnosis. Surgical resection with negative margin is the treatment of choice for gastric glomus tumors. CONCLUSION Although gastric glomus tumor is a rare entity and accounts for 1% of all gastric mesenchymal tumors, it should be considered in the differential diagnosis, since preoperative biopsy is difficult and overlapping features with other submucosal lesions. Surgical treatment is the preferred option for gastric glomus tumor and long-term follow-up is required due to high metastatic and recurrence rate in the malignant type.
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Affiliation(s)
| | - Zainab M Alfaraj
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jihad AlSafwani
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | | | - Ridha H AlKhalifah
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | | | - Sami A Al-Momen
- Department of Internal Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Qassim Aldolah
- Department of General Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
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Singh S, Kumar A, Singh V. Gastric Glomus Tumor. Niger J Surg 2020; 26:162-165. [PMID: 33223817 PMCID: PMC7659754 DOI: 10.4103/njs.njs_8_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
This case report describes glomus tumor of the stomach, a rare entity, which is a mesenchymal origin tumor. They are generally benign and account for nearly 1% of all gastrointestinal (GI) soft-tissue tumors. They are almost impossible to diagnose preoperatively because of the lack of specific characteristics and are often mistaken for GI stromal tumors (GISTs). In our hospital setup, a female aged 24 years, presented with right lumbar abdominal pain which after a thorough workup leads to the preoperative diagnosis of GIST, and distal gastrectomy with Roux-en-y anastomosis was done. However, pathological and immunohistochemical findings done after the surgery were found consistent with the diagnosis of gastric glomus tumor. Discovered on GIST-1 (DOG-1) nonreactivity is considered for the diagnosis of glomus tumor which helps in excluding the diagnosis of GIST, which is positive for DOG-1. Hence, it was concluded that differential diagnosis on the basis of immunohistochemical findings can lead to an accurate preoperative diagnosis and further targeted surgical intervention.
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Affiliation(s)
- Sumitoj Singh
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Ashok Kumar
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
| | - Vikas Singh
- Department of General Surgery, Government Medical College, Amritsar, Punjab, India
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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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Arias-Romano AJ, Puya-Gamarro M, Rodríguez-Lobalzo SA, Bercedo-Martínez J. Tumor glómico gástrico: un reto en el diagnóstico preoperatorio de las lesiones subepiteliales del estómago. GASTROENTEROLOGIA Y HEPATOLOGIA 2018; 41:670-671. [DOI: 10.1016/j.gastrohep.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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Abstract
RATIONALE Glomus tumors (GTs) are a rare disorder originating from the glomus of the anastomoses of small arteries, usually occurring in the subungual region of the fingertips or toes and seldom occurring in the stomach. We unintentionally found a case of a gastric glomus tumor (GGT) without any upper abdominal discomfort. The diagnosis of this disease was mainly by immunohistochemistry. PATIENT CONCERNS The patient presented to our hospital with intermittent right abdominal pain for 1 month. Abdominal computed tomography showed a nodular enhancement lesion in the gastric antrum. DIAGNOSES The patient was diagnosed with an ileocecal tumor and a gastric stromal tumor. INTERVENTIONS Surgical resection of the ileocecal and gastric tumors was performed. OUTCOMES Pathologic examination of gastric masses revealed GT. The operation was effective, and the patient was discharged from our hospital 7 days after surgery. Upon follow-up at 3 months, the patient was asymptomatic. LESSONS GTs are submucosal tumors rarely found in the stomach. Surgical resection is a good choice of treatment. The GGT lacked specific clinical and imaging features, and immunohistochemistry was essential in the diagnosis of GGT.
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Affiliation(s)
- Menghui Wu
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
| | - Tianyu Zhou
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
| | - Donghui Cao
- Department of Clinical Research, The First Hospital of Jilin University
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xueyuan Cao
- Department of Gastric and Colorectal Surgery, The First Hospital of Jilin University
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Masouminia M, Ghani HA, Foote D, Hari D, French S. Rare presentation of the glomus tumor in the stomach. Exp Mol Pathol 2017; 104:9-11. [PMID: 29221662 DOI: 10.1016/j.yexmp.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Maryam Masouminia
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Hassan Abdul Ghani
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Dingle Foote
- Department of Radiology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Danielle Hari
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Samuel French
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States.
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A gastric glomus tumor resected using non-exposed endoscopic wall-inversion surgery. Clin J Gastroenterol 2017; 10:508-513. [PMID: 29039113 DOI: 10.1007/s12328-017-0782-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
Gastric glomus tumors are extremely rare, constituting approximately 1% of gastric mesenchymal tumors. We report the case of a 45-year-old female patient in whom upper gastrointestinal endoscopy revealed a 3-cm submucosal tumor with a bridging fold in the posterior wall of the antrum of the stomach. Contrast-enhanced computed tomography revealed the tumor to be hypervascular in the arterial phase and exhibit continuous enhancement in the post-venous phase. Dynamic contrast-enhanced magnetic resonance imaging showed that the tumor was hypervascular in the early phase and persistently enhanced in the late phase. Endoscopic ultrasonography revealed a mosaic echo pattern. Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed. Immunohistochemical examination revealed that the tumor was positive for α-smooth muscle actin and synaptophysin, but negative for CD56, chromogranin A and C-kit. Furthermore, 1-2% of the tumor cell nuclei were Ki-67-positive. Thus, the preoperative diagnosis was a benign glomus tumor. The patient then underwent non-exposed endoscopic wall-inversion surgery (NEWS), and the tumor was completely resected. In conclusion, NEWS is an effective method for the treatment of gastric glomus tumors.
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Abstract
Gastric glomus tumors are rare, mesenchymal neoplasms, generally described as benign and account for nearly 1% of all gastrointestinal soft tissue tumors. The most common gastrointestinal site of involvement is the stomach, particularly the antrum. Gastric glomus tumors are submucosal tumors that lack specific clinical and endoscopic characteristics, and are often mistaken for the more common gastrointestinal stromal tumors. A 62-year-old Caucasian female presented with shortness of breath and a persistent cough. Clinical workup revealed a mass in the upper abdomen. After endoscopic ultrasound and fine needle aspiration raised concerns for cancer, the patient elected to proceed with exploratory laparotomy. A local resection was performed at the time of surgery. Pathologic and immunohistochemical findings following surgical resection were consistent with a gastric glomus tumor. Consideration of gastric glomus tumors in the differential diagnosis may optimize the chance for a more accurate preoperative diagnosis and targeted surgical intervention.
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Affiliation(s)
| | | | - Renato G Albaran
- Crittenton Hospital Medical Center, Rochester Hills, MI 48307, USA
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