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Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 509-510
Gastric glomus tumor: A brief report

Department of Pathology, Government Medical College, Kottayam, Kerala, India

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Date of Web Publication14-Aug-2014

How to cite this article:
Thambi R, Sheeja S, Joesph CP, Poothiode U. Gastric glomus tumor: A brief report. Indian J Pathol Microbiol 2014;57:509-10

How to cite this URL:
Thambi R, Sheeja S, Joesph CP, Poothiode U. Gastric glomus tumor: A brief report. Indian J Pathol Microbiol [serial online] 2014 [cited 2021 Nov 27];57:509-10. Available from: https://www.ijpmonline.org/text.asp?2014/57/3/509/138809


A 60-year-old female patient presented with the complaints of abdominal pain for past 2 months. Endoscopy was suggestive of gastrointestinal stromal tumor (GIST). Contrast enhanced computed tomography showed a well-defined lesion with good central contrast enhancement in the posterior wall of stomach. Guided fine needle aspiration cytology was suggestive of neuroendocrine tumor. Wide excision specimen showed a circumscribed gray white and firm lesion involving the submucosa and muscularis propria [Figure 1]a. Microscopy showed perivascular sheets of round cells with eosinophilic cytoplasm and round uniform nuclei. Atypical mitosis, vascular, lymphatic, or neural invasion were not seen [Figure 1]b and c]. Immunohistochemistry showed smooth muscle actin positivity [Figure 1]]. Synaptophysin and chromogranin were negative excluding carcinoid tumor. Nonspecific enolase (NSE) showed cytoplasmic positivity possibly due to the nonspecific reaction of NSE or polyclonal antibody used [Figure 1]e and f. CD117, CD34 and desmin were also negative ruling out GIST and leiomyoma [Figure 2]. Final diagnosis of glomus tumor of the stomach was given. The patient is on follow up and doing well.
Figure 1: (a) Circumscribed gray white lesion involving the submucosa and muscularis propria. (b and c) Perivascular arrangement of round cells with eosinophilic cytoplasm and round uniform nuclei. (d) Immunohistochemistry showed smooth muscle actin positivity. (e) Chromogranin was negative in the neoplastic cells. (f) Nonspecific enolase showed faint cytoplasmic positivity

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Figure 2: (a) CD117. (b) CD34. (c) Synaptophysin. (d) Desmin

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Stomach is a common extracutaneous site of glomus tumor and constitute about 1% of gastric mesenchymal tumors. [1] After the first description of gastric glomus tumor in 1951 by Key et al. only few cases have been reported. Symptomatic cases present with epigastric discomfort, hematemesis, malena, nausea or vomiting; rarely large tumors cause gastric ulcer or bleeding. [1],[2],[3] females of fifth to sixth decade are frequently. Most gastric glomus tumors are antral submucosal nodules of 1-5 cm. [3] Glomus tumors have to be differentiated from carcinoid tumors, GISTs and other mesenchymal neoplasms. [1],[2] Due to the deep location of glomus tumor, preoperative diagnosis is difficult. Computed tomography scan shows well-circumscribed submucosal mass with homogeneous density and tiny flecks of calcification and contrast enhancement show hypervascularity. Similar features can be seen in endocrine tumors and GISTs. Endoscopic ultrasound fine-needle aspiration (FNA) rarely contributes to the preoperative diagnosis. In our case, FNA was given as neuroendocrine tumor. [2]

Microscopy of the tumor showed perivascular aggregates and sheets of uniform cells with eosinophilic and focally clear cytoplasm, sharp cell borders, and accentuated with reticulin. [1],[2],[4] The lesions are often surrounded by hyperplastic smooth muscle cells and proliferating nerve bundles. [4] Difficult cases need immunohistochemical markers to identify the cell of origin. [2]

Criteria for malignant glomus tumors of soft tissue proposed by Folpe et al. included: (a) Deep location and size >2 cm or (b) atypical mitotic figure or (c) moderate to high nuclear grade and mitotic activity (5 mitoses/50 HPF). [3],[4],[5] There seems to be a marked difference in clinical course of glomus tumors in deep peripheral soft tissue and those in the stomach. For gastric glomus tumors, size >5 cm is more important than the mitosis and atypia for assessing risk for malignancy. [3] Treatment of choice for gastric glomus tumor is wedge resection with negative margins. Completely resected small tumors without necrosis and mitosis have good prognosis.

Gastric glomus tumors should always be included in the differential diagnosis of submucosal gastric lesions, keeping in mind that preoperative investigation of these patients often yield misleading results.

   Acknowledgment Top

I would like to acknowledge Dr. Bhavya P Mohan, assist. Professor for helping with the IHC markers and Dr. Aparna, junior resident for the assistance given in collecting the case details and references.

   References Top

Vassiliou I, Tympa A, Theodosopoulos T, Dafnios N, Fragulidis G, Koureas A, et al. Gastric glomus tumor: A case report. World J Surg Oncol 2010;8:19.  Back to cited text no. 1
Athanazio DA, Motta MP, Motta A, Studart E, Athanazio PRF. Differential diagnosis between glomus tumor and carcinoid of the stomach. GE J Port Gastrenterol 2009;16:29-32.  Back to cited text no. 2
Kang G, Park HJ, Kim JY, Choi D, Min BH, Lee JH, et al. Glomus tumor of the stomach: A clinicopathologic analysis of 10 cases and review of the literature. Gut Liver 2012;6:52-7.  Back to cited text no. 3
Gombos Z, Zhang PJ. Glomus tumor. Arch Pathol Lab Med 2008;132:1448-52.  Back to cited text no. 4
Folpe AL, Fanburg-Smith JC, Miettinen M, Weiss SW. Atypical and malignant glomus tumors: Analysis of 52 cases, with a proposal for the reclassification of glomus tumors. Am J Surg Pathol 2001;25:1-12.  Back to cited text no. 5

Correspondence Address:
Renu Thambi
Department of Pathology, Government Medical College, Kottayam, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.138809

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