Gastric glomus tumor: a rare case of dyspepsia.

Gastric glomus tumors (GGTs) are rare mesenchymal tumors of the gastrointestinal tract originating in the neuromyoarterial glomus [1] and accounting for 1% of gastrointestinal stromal tumors (GISTs). GGTs are generally considered to be clinically benign [2], but malignant behavior cannot be excluded [3,4]. They present as submucosal masses that project into the lumen or out onto the serosa [5] and are distinct lesions that should be considered in the differential diagnosis of a gastric submucosal mass. In the case presented here, a 54-year-old man was admitted to our surgical department with intermittent epigastric pain and dyspepsia. Gastroscopy revealed the presence of a smooth submucosal mass in the gastric antrum, measuring 10mm in diameter. A computed tomography (CT) scan confirmed the presence of the mass and showed no evidence of metastasis (●" Fig.1). Endoscopic ultrasound (EUS) demonstrated the presence of a homogeneous hypoechoic mass arising from the muscularis propria (●" Fig.2). A partial gastrectomy with a Billroth II reconstruction was performed, and the patient was discharged after 7 days. Microscopically the tumor consisted of medium-sized cells with low proliferative activity (●" Fig.3). The results of immunohistochemical analysis of the specimen are given in●" Table1. After 36 months of follow-up the patient shows no signs of recurrence. GGTs are often confused with GISTs or neuroendocrine tumors [6]. EUS helps to identify the layer of origin [1], which is usually the third and/or fourth layer. A CT scan will show strong enhancement, but does not help with the differentiation of GGTs from other submucosal lesions, such as carcinoid, ectopic pancreas, and some GISTs [1]. Immunohistochemical studies have revealed that the cells of a GGT are positive for smooth muscle actin and muscle-specific actin [6]. Endoscopic full-thickness resection is a safe and feasible procedure [7], but the possible approaches (laparotomy/laparoscopy or an endoscopic technique) should be discussed with the patient, taking account of the experience of the center.