Glomus Tumor of the Stomach: A Rare Cause of Upper Gastrointestinal Bleeding

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.

Gastric glomus tumor

“…GGTs usually arise in the intramuscular layer and typically occur as a solitary, submucosal nodule that most frequently affects the greater curvature, antrum, and pylorus [2]. The prevalence of GGTs is dominant in females in the fifth or sixth decade, but a wide range of ages has been encountered [6].…”

“…The prevalence of GGTs is dominant in females in the fifth or sixth decade, but a wide range of ages has been encountered [6]. The incidence of GGTs is much less common than GISTs with only 1 in 100 diagnoses of GISTs being gastric GT [2]. GIST is the most common submucosal tumor of the stomach and is often included in the differential diagnosis of GGTs.…”

“…On CT, they manifest as well-circumscribed submucosal masses with homogeneous density on unenhanced study and may contain tiny flecks of calcifications [2]. However, it is important to note that imaging techniques fail to differentiate GTs from other stromal or mesenchymal lesions.…”

“…However, it is important to note that imaging techniques fail to differentiate GTs from other stromal or mesenchymal lesions. The above-mentioned imaging features can also be seen with other mesenchymal tumors, such as neuroendocrine tumors, GIST, schwannoma and vascular tumors such as hemangioma and hemangiopericytoma [2]. EUS will show a hypoechoic, well-circumscribed mass located in the submucosa and/or muscularis propria [6, 7].…”

“…These tumors represent approximately 2% of all soft tissue tumors and are commonly found on extremities. GTs rarely involve visceral organs, although tumors in the tympanum, mediastinum, trachea, kidney, uterus, vagina and stomach have been described previously [2]. …”