University of Minnesota Medical Center Minneapolis, MN, United States
Echko Holman, MD1, Nicholas M. McDonald, MD1, Robin Solomon, MD2, Mohammad Bilal, MD3 1University of Minnesota Medical Center, Minneapolis, MN; 2Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; 3Minneapolis VA Health Care System, Minneapolis, MN
Introduction: Glomus tumors of the gastrointestinal tract are exceedingly rare and are typically benign lesions, though they can have malignant potential. Gastric glomus tumors account for approximately 1% of all gastric neoplasms. Like other subepithelial lesions, these are often incidentally found during upper endoscopy and are indistinguishable from other subepithelial lesions using white light endoscopy. In these cases, determining which layer the lesion arises from and obtaining a tissue biopsy are critical to determining the diagnosis and next steps for management. In this case, endoscopic ultrasonography and fine needle biopsy (EUS-FNB) successfully confirmed the diagnosis of gastric glomus tumor.
Case Description/Methods: A 58-year-old male was incidentally found to have a gastric mass on computed tomography (CT) scan of the abdomen for an episode of epigastric abdominal pain. The CT scan revealed a 25 x 19 x 20 mm intraluminal density along the greater curvature of the distal stomach (A). An upper endoscopy was performed and a subepithelial lesion was seen in the gastric antrum (B). Endoscopic ultrasound revealed a hypoechoic (30 x 20 mm) well defined oval subepithelial lesion appearing to originate from muscularis propria (C). EUS guided fine needle biopsy was performed and pathology revealed a neoplasm composed of uniform, round cells, with sheets and cords that were positive for SMA, synaptophysin and DOG1, consistent with glomus tumor (D). The patient was evaluated by general surgery and surgery is planned.
Discussion: Gastric glomus tumors are indistinguishable from other subepithelial lesions on both CT scan and EUS. Immunohistochemical testing, histopathology and molecular testing, are essential to establish the diagnosis. Given their low prevalence, there are no evidence based standardized treatment recommendations. As potential malignant transformation cannot be reliably prognosticated on immunohistopathology and given prior rare reports of metastasis, surgery can be considered. It is important to include glomus tumor on the differential diagnosis of gastric subepithelial lesions as disease recurrence is extremely rare after surgical excision.
Figure: A) CT showing a 25 x 19 x 20 mm intraluminal density along the greater curvature of the distal stomach. B) White light endoscopy with subepithelial lesion in the gastric antrum. C) Endoscopic ultrasound revealed a hypoechoic (30 x 20 mm) well defined oval subepithelial lesion appearing to originate from muscularis propria. D) Histology showing uniform, round cells, with sheets and cords consistent with glomus tumor.
Disclosures:
Echko Holman indicated no relevant financial relationships.
Nicholas McDonald indicated no relevant financial relationships.
Robin Solomon indicated no relevant financial relationships.
Mohammad Bilal indicated no relevant financial relationships.
Echko Holman, MD1, Nicholas M. McDonald, MD1, Robin Solomon, MD2, Mohammad Bilal, MD3. P2777 - The Onus of the Glomus: A Case Report of a Gastric Glomus Tumor, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
