BACKGROUND: Glomus tumors (GTs) are mesenchymal neoplasms that are typically benign. Gastric GTs are uncommon and occur mainly in the upper gastrointestinal tract. Malignant gastric GTs are extremely rare, constituting less than 1% of gastric tumors. Because their features are similar to those of other tumors found in the same gastrointestinal region, such as stromal tumors, leiomyomas, lymphomas, and lipomas, the diagnosis is challenging. CASE PRESENTATION: A 52-year-old male patient presented with fatigue and melena. The initial endoscopic examination did not locate any source of bleeding. Six months later, pan-gastroscopy, performed due to progressive microcytic anemia, revealed a 40 × 30 mm polypoid lesion with deep ulcerations; histopathological analysis confirmed that it was a gastric GT with expression of alpha-actin and cadherin 17 and a Ki-67 index of 20%. The patient delayed surgical therapy until his symptoms worsened. Laparoscopic sleeve resection revealed a 65 × 45 × 25 mm tumor, and secondary immunohistochemical analysis revealed extensive spread into the mucosa and subserosa. Focally, the tumor bulged into some large veins. Genetic examination with RNA isolation further supported the histopathological diagnosis of gastric GT with uncertain malignant potential. CONCLUSIONS: This case underscores the diagnostic challenges posed by gastric GTs because they are rare and their clinical features are similar to those of other gastric tumors. Thorough histopathological and molecular analysis is essential for an accurate diagnosis. Surgical intervention remains the primary therapeutic approach. This case also emphasizes the need for long-term follow-up due to the potential for recurrence and malignancy.

Bioptical Laboratory Ltd Pilsen Czech Republic

Department of Internal Medicine Hódmezővásárhely Makó Healthcare Center Makó Hungary

Department of Pathology Albert Szent Györgyi Medical School University of Szeged Szeged Hungary

Department of Surgery Albert Szent Györgyi Health Center University of Szeged Semmelweis Street 8 Szeged H 6725 Hungary

Institute for Surgical Research Albert Szent Györgyi Medical School University of Szeged Szeged Hungary

Laboratory of Tumor Pathology and Molecular Diagnostics Szeged Hungary

Zobrazit více v PubMed

Gombos Z, Zhang PJ. Glomus tumor. Arch Pathol Lab Med. 2008;132(9):1448–52. 10.5858/2008-132-1448-GT. PubMed

Masson P. Le glomus Neuromyoarterial Des regions tactiles et ses tumeurs. Lyon Chil. 1924;21:257–80.

Kay S, Callahan WP, Murray MR, Randall HT, Stout AP. Glomus tumors of the stomach. Cancer. 1951;4(4):726–36. 10.1002/1097-0142(195107)4:4%3C726::aid-cncr2820040410%3E3.0.co;2-z. PubMed

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):1–12. 10.1097/00000478-200101000-00001. PubMed

Tripodi SA, Rocca BJ, Mourmouras V, Barbanti G, Colecchia M, Ambrosio MR. Benign glomus tumor of the urinary bladder. Arch Pathol Lab Med. 2013;137:1005–8. 10.5858/arpa.2012-0125-CR. PubMed

Mosquera JM, Sboner A, Zhang L, Chen CL, Sung YS, Chen HW, Agaram NP, Briskin D, Basha BM, Singer S, Rubin MA, Tuschl T, Antonescu CR. Novel MIR143-NOTCH fusions in benign and malignant glomus tumors. Genes Chromosomes Cancer. 2013;52:1075–87. 10.1002/gcc.22102. PubMed PMC

Wang Q, Zhao N, Kennard S, Lilly B. Notch2 and Notch3 function together to regulate vascular smooth muscle development. PLoS ONE. 2012. 10.1371/journal.pone.0037365. PubMed PMC

Brouillard P, Olsen BR, Vikkula M. High-resolution physical and transcript map of the locus for venous malformations with glomus cells (VMGLOM) on chromosome 1p21-p22. Genomics. 2000;67:96–101. 10.1006/geno.2000.6232. PubMed

Duan K, Chetty R. Gastric glomus tumor: clinical conundrums and potential mimic of gastrointestinal stromal tumor (GIST). Int J Clin Exp Pathol. 2017;10(7):7905–12. PubMed PMC

Gralnek IM, StanleyAJ, Morris AJ, Camus M, Lau J, Lanas A, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy. 2021;53(3):300–32. PubMed

Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc care. 2024;13(1):55–161. PubMed

Fejes R, Szűcsborus T, Czombos A, Góg C, Ruzsa Z. Managing patients with concurrent high risk for bleeding and thromboembolic events. Cureus. 2024;16(2):e53557. 10.7759/cureus.53557. PubMed PMC

Alsahwan AG, Alfaraj ZM, AlSafwani J, Bunaiyan AH, AlKhalifah RH, Al-Saba’a SA, Al-Momen SA, Aldolah Q. Rare gastric neoplasm: malignant glomus tumor of the stomach. A case report. Int J Surg Case Rep. 2021;81:105802. 10.1016/j.ijscr.2021.105802. PubMed PMC

Ehrlich D, Mukewar S, Wang H, Muthusamy VR. Bite-on-bite technique for removal of a gastric subepithelial lipoma. VideoGIE. 2019;4(3):108–10. PubMed PMC

Kajiyama T, Hajiro K, Sakai M, Inoue K, Konishi Y, Takakuwa H, et al. Endoscopic resection of gastrointestinal submucosal lesions: a comparison between strip biopsy and aspiration lumpectomy. Gastrointest Endosc. 1996;44(4):404–10. PubMed

Kato S, Kikuchi S, Chinen K, Murakami T, Kunishima F. Diagnostic utility of endoscopic ultrasound-guided fine-needle aspiration biopsy for glomus tumor of the stomach. World J Gastroenterol. 2015;21:7052–8. PubMed PMC

Liu KL, Wang HP, Tseng WY, Shun CT, Chen SJ, Tsang YM. Glomus tumor of the stomach: MRI findings AJR Am. J Roentgenol. 2005;185:1190–2. PubMed

Tang M, Hou J, Wu D, Han XY, Zeng MS, Yao XZ. Glomus tumor in the stomach: computed tomography and endoscopic ultrasound findings. World J Gastroenterol. 2013;19:1327–9. PubMed PMC

Jacobson BC, Bhatt A, Greer KB, Lee LS, Park WG, Sauer BG, Shami VM. ACG clinical guideline: diagnosis and management of gastrointestinal subepithelial lesions. Am J Gastroenterol. 2023;118(1):46–58. PubMed

Fang HQ, Yang J, Zhang FF, Cui Y, Han AJ. Clinicopathological features of gastric glomus tumor. World J Gastroenterol. 2010;16:4616–20. PubMed PMC

Wang ZB, Yuan J, Shi HY. Features of gastric glomus tumor: a clinicopathologic, immunohistochemical, and molecular retrospective study. Int J Clin Exp Pathol. 2014;7(4):1438–48. PubMed PMC

Mohamed WT, Jahagirdar V, Jaber F, Ahmed M, Fatima I, Chhabra R, Tawfik O. Glomus Tumor of the stomach presenting with Upper gastrointestinal bleeding: a Case Report. J Investig Med High Impact Case Rep. 2023. 10.1177/23247096231192891. PubMed PMC

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. 10.1097/00000478-200203000-00003. PubMed

Mengoli MC, Nosseir S, Mataca E et al. Epidemiologic, clinicopathological, immunohistochemical, and molecular analysis of gastrointestinal glomus tumors. J Clin Exp Pathol. 2014:4.

Kirschbaum D, Teitelman L. Malignant tumor of the omentum simulating glomangioma Arch. Pathol. 1939;27:95.

Bray AP, Wong NA, Narayan S. Cutaneous metastasis from gastric glomus tumour. Clin Exp Dermatol. 2009;34(8):e719–21. 10.1111/j.1365-2230.2009.03445.x. PubMed

Song SE, Lee CH, Kim KA, Lee HJ, Park CM. Malignant glomus tumor of the stomach with multiorgan metastases: report of a case. Surg Today. 2010;40(7):662–7. 10.1007/s00595-008-4113. -z F.M. PubMed

Enzinger SW. Benign Vascular Tumors and Malformations. In: Weiss SW, Goldblum JR, Folpe A, editors. Soft Tissue Tumors, 7th Edition, St. Louis: Mosby; 2020. pp. 848–850.

Oruc MT, Cakir T, Aslaner A, Cekic S, Sakar A, Yardimci EC. Incidental gastric glomus tumor after laparoscopic sleeve gastrectomy autopsy. Case Rep. 2016;6:47–50. 10.4322/acr.2016.028. PubMed PMC

Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM. Sleeve gastrectomy: Surgical Tips. J Laparoendosc Adv Surg Tech. 2018;28(8):930–7. PubMed

Topart P, Becouarn G, Ritz P. Should biliopancreatic diversion with duodenal switch be done as single-stage procedure in patients with BMI > or = 50 kg/m2? Surg Obes Relat Dis. 2010;6(1):59–63. PubMed

Ali M, El Chaar M, Ghiassi S, Rogers AM, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652–7. PubMed