Glomus Tumor of the Stomach: A Systematic Review and Illustrative Case Report

Abstract

<b><i>Introduction:</i></b> Glomus tumor (GT) is a rare mesenchymal neoplasm that can be found anywhere throughout the body, including the stomach. Our goal was to present a case and a systematic review of the literature, reporting clinical, radiological, surgical, and pathological features of the disease. <b><i>Methods:</i></b> We reviewed Pubmed and SCOPUS for all case reports and case series published after 2000. Papers written in languages different from English and letters to the editor were excluded. Screening and data extraction were performed following the PRISMA guidelines. <b><i>Results:</i></b> A total of 89 studies were included in the systematic review, consisting of 187 cases of gastric glomus tumor. Mean age was 52 (18–90); most patients were female (61%). The most common clinical presentation was epigastric pain (33.9% of cases). The gastric antrum was the most frequently involved site (75.3%). Mean tumor size was 2.82 cm (0.8–17). Preoperative diagnosis was achieved in 22 cases, mostly by endoscopic ultrasound (EUS)-guided biopsy. Wedge resection was performed in 62% of treated patients. Smooth muscle actin was expressed in all cases with available immunohistochemistry. Malignant GT was reported in 11 cases. <b><i>Discussion:</i></b> Epigastric pain and bleeding were the most common symptoms at presentation in patients with diagnosis of glomus tumor. EUS-guided fine needle aspiration can be useful for preoperative diagnosis. Endoscopic elastosonography is a promising tool for the differential diagnosis of gastric submucosal lesions, including glomus tumors. The treatment of choice is wedge resection with adequate free margins. A laparoscopic approach is warranted when technically feasible. Since malignant gastric GTs have been described, long-term follow-up is suggested after surgical excision.

Clinicopathologic features of gastric glomus tumor: A report of 15 cases and literature review

“…GGT is relatively rare. Previous reports are mostly dominated by one case, while the reports of a series of cases have gradually increased in recent years [ 26 , 27 ]. It remains on debate whether the standard proposed by Folpe et al [ 2 ] is applicable for GGT.…”

“…However, it is important to note that the assessment of nuclear atypia is subjective, and metastatic GGT has previously reported only mild cytologic atypia and a small amount of mitosis [ 3 ]. Therefore, Pansa et al [ 26 ] believed that the absence of severe cell atypia and mitosis do not exclude malignant potential.…”

A Rare Gastric Subepithelial Lesion Removed through Submucosal Tunneling Endoscopic Resection: Case Report and Literature Review

“…Among the patients who underwent endoscopic ultrasound-guided fine-needle aspiration to determine the pathology, a diagnosis was correctly given in only 8 out of 13 cases [ 13 ]. Although EUS-guided biopsy has been reported to be able to provide an accurate diagnosis in some cases, resection might be a more favorable alternative for both diagnosis and treatment [ 4 , 14 ].…”

“…Glomus tumors are typically benign, and the guidelines released by the European Society of Gastrointestinal Endoscopy in 2022 indicate that no surveillance is required if the diagnosis is clear because only anecdotal evidence supports that a risk of malignancy or complications is present [ 4 ]. However, in a systematic review of 187 cases of gastric glomus tumors, 11 cases involved malignant glomus tumors [ 14 ].…”

“…Because glomus tumors are potentially malignant, if removal is planned, a local operation for complete resection is typically recommended, and such operations are indeed performed in most cases in the literature [ 14 ]. However, surgical resection often requires sacrificing a considerable amount of stomach tissue.…”