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| Year : 2009 | Volume
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| Issue : 1 | Page : 77-79 |
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| Glomus tumor of the stomach |
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RB Batra, Anurag Mehta, PV Rama Mohan, KJ Singh
Department of Pathology, Armed Forces Medical College, Pune - 411 040, India
Click here for correspondence address and email
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 Abstract | | |
Gastric glomus tumors are rare neoplasms. We report here a case of gastric glomus tumor in a 25-year-old female who presented with exsanguinating gastrointestinal hemorrhage. Clinically and on gross examination, the tumor was suspected to be a gastrointestinal stromal tumor (GIST). Histopathological and immunohistochemical evaluation revealed it to be a glomus tumor. Keywords: Gastrointestinal hemorrhage, glomus tumor, stomach
How to cite this article:
Batra R B, Mehta A, Rama Mohan P V, Singh K J. Glomus tumor of the stomach. Indian J Pathol Microbiol 2009;52:77-9 |
| Introduction | |  |
Glomus tumor, mainly a subungual tumor, has been varyingly described at other sites including viscera. The stomach has been described as a rare site for glomus tumor. In the stomach, the glomus tumor is often confused with a gastrointestinal stromal tumor (GIST) or neuroendocrine tumors on microscopy. We report here an unusual case of glomus tumor in a young female who presented with exsanguinating gastrointestinal bleeding and severe anemia. The case also posed a diagnostic dilemma both on initial and subsequent clinical examination.
| Clinical Summary | | |
A 25-year-old female presented in June 2007 with pain in the upper abdomen and a massive upper gastrointestinal bleed for which she required resuscitation with intravenous fluids and blood. The hemoglobin (Hb) had fallen precipitously to 5 gm% and her hematocrit was 16%. An evaluation by Upper Gastro Intestinal Endoscopy (UGIE) and an ultrasound did not reveal any positive finding.
She remained asymptomatic until December 2007 when she again presented with pain in the upper abdomen, occasional vomiting and dyspepsia. There was no hematemesis, malena, weight loss, anorexia, or fever. A general and systemic examination revealed no positive findings except for pallor. Investigations confirmed the anemia. A UGIE showed a large smooth submucosal mass lesion with central ulceration at the incisura angularis [Figure 1] suggestive of a submucosal gastric tumor possibly leiomyoma or a gastrointestinal stromal tumor. A contrast enhanced computed tomography (CECT) of the abdomen showed a well-defined rounded soft tissue growth arising from the submucosa at the incisura and significantly enhancing with IV contrast. The rest of the viscera was normal. Surgery was performed on 31/1/08, which confirmed a submucosal mass appearing as a bulge near the antrum without involvement of the serosa. A distal gastrectomy with a Bilroth I reconstruction was performed.
Pathological findings
A partial gastrectomy specimen was received that showed a submucosal tumour measuring 3.5cm x 2.5 cm x 2.5 cm [Figure 2]. There was a bulge in the mucosa with a small mucosal ulceration. Cut surface revealed a grayish-white fleshy tumor. Sections of the tumor revealed that it comprised of monomorphic cells arranged in sheets and in nests with interspersed blood vessels [Figure 3]. These cells had a central nondescript nucleus and abundant clear cytoplasm. Each cell showed a well delineated cell membrane [Figure 4]. A glomus tumor and carcinoid were considered as the two differentials. A diagnosis of glomus tumor was favored because of the well delineated cells and clear cytoplasm. Immunohistochemistry confirmed the diagnosis by revealing that these cells were positive for Vimentin and Smooth muscle actin [Figure 5] and [Figure 6] and negative for chromogranin. [Figure 7].
| Discussion | | |
Gastric glomus tumors are rare neoplasms. Most series have found a female predominance with an age range between 19 and 90 years. [1],[2] Most cases present with gastrointestinal bleeding and ulcer-like symptoms. However, exsanguinating gastrointestinal hemmorrhage is rare. Recovery from the hemmorrhage is usually the rule, except for occasional patients who have died because of severe hemmorrhage. [3]
The three series quoted above mention that the tumors have been found to be common in the gastric antrum as has also been illustrated by our case. [1],[2],[3] The largest series of 32 cases has been reported from the Armed Forces Institute of Pathology. Mucosal ulceration as also seen in our case was noticed in 14 of their cases. However, other histological features reported by the authors like mitotic activity, vascular invasion and focal atypia were not seen in our case. [2] Immunohistochemically, all tumors were positive for alpha-smooth muscle actin but none was positive for chromogranin as illustrated by our case. Immunohistochemistry helps in differentiating the tumor from carcinoid, for which it can be easily mistaken. [4]
| Conclusion | | |
Glomus tumors of the stomach are quite rare. They usually present in the antral region and are usually submucosal. Clinically, they are often mistaken for gastrointestinal stromal tumors. Histopathologically, they need to be differentiated from carcinoids in which immunohistochemistry is of help. They present a diagnostic dilemma to both the clinician and the histopathologist.
| References | | |
| 1. | Lee HW, Lee JJ, Yang DH, Lee BH. A clinicopathologic study of glomus tumour of the stomach. J Clin Gastroentrol 2006;40:717-20.  |
| 2. | Miettinen M, Paal E, Lasota J, Sobin LH. Gastrointestinal glomus tumors: A clinicopathologic, immunohistochemical and molecular genetic study of 32 cases. Am J Surg Pathol 2002;26:301-11. [PUBMED] [FULLTEXT] |
| 3. | Fieber SS, Schafer H. Glomus tumour of the stomach. Ann Surg 1964;160:232-8. [PUBMED] [FULLTEXT] |
| 4. | Chang SM, Ho WL. Glomus tumor of the stomach: A case report. Zhonghua Yi Xue Za Zhi (Taipei) 1993;52:276-9. [PUBMED] |
Correspondence Address:
R B Batra
Department of Pathology, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.44972
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7] |
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