Gastric Angiomyolipoma, a Very Rare Cause of Upper Gastrointestinal Bleeding: A Case Report and a Brief Review of Literature

Abstract

Angiomyolipoma (AML) is a tumor composed of variable proportions of adipose tissue, spindle and epithelioid smooth muscle-like cells and abnormal thick-walled blood vessels which are usually benign. AML is relatively common in kidney and liver. Gastric angiomyolipoma (GAML) is extremely rare and only 2 cases were reported in the literature. Diagnosis of AML is difficult owing to its rarity and varied immunohistochemical patterns. Here, we report a case of GAML in a 65-year-old male who presented with an episode of hematemesis and intermittent melena for one week. Endoscopy showed a partially obstructing mass arising from gastric antrum with central ulceration. Mass was removed by wedge resection after laparoscopic anterior gastrectomy. Excised specimen showed a benign 6 × 3 × 3 cm homogenous fatty mass with adipose tissue, smooth muscles and prominent vascularity. Immunohistochemistry stains were positive for desmin, smooth muscle actin (SMA), CD34 and negative for human melanoma black (HMB)-45 antigen and CD117. This case reports the largest and HMB-45 negative GAML so far, which can be a very rare cause of upper gastrointestinal bleeding.

Gastric Angiomyolipoma Masquerading as Gastric Malignancy

“…Because of the vascular nature of the tumor, GAML has a predilection to present with upper GI bleeding 6. This was seen in our case and also described previously 2 , 7. Therefore it must be considered as a rare cause of upper GI bleed associated with a neoplasm.…”

“…Like renal AML, an extrarenal AML may arise sporadically or in association with tuberous sclerosis 3. The largest GAML previously reported in the literature is 6 × 3 × 3 cm 2. Our patient’s AML was 9 × 6 × 5 cm, and we had the additional finding of associated multiple enlarged regional reactive lymph nodes, which has not been described with GAML previously.…”

“…Extrarenal AMLs are rare and have been reported in the nasal cavity, oral cavity, lung, chest wall, skin, ear, breast, heart, spinal cord, spermatic cord, penis, vaginal wall, adrenal gland, anterior mediastinum, and uterus 5. In the gastrointestinal (GI) tract, it has been reported in the liver and less commonly in the duodenum, appendix, pancreas, and stomach 2…”

“…Diagnosis with endoscopy can be difficult because of nonspecific mucosal features and inadequate depth on routine biopsy specimens 6. Two of the previously reported cases of GAML were polypoidal on EGD with central ulceration located in the gastric body and the pylorus, respectively 2 , 7. Another case reported a mass with ulceration in the antrum 6.…”

“…Extrarenal AML is rare and are usually observed as “incidentalomas” during imaging for other diseases 1. Gastric AML (GAML) is extremely rare, with only 3 cases reported in the literature 2…”