CASE CoMMUNICATIONS IMAJ • VOL 14 • MArch 2012 Glomus Tumor of the Stomach Andronik Kapiev MD1, Ron Lavy MD1, Judith Sandbank MD2 and Ariel Halevy MD1 1Division of General Surgery and 2Institute of Pathology, Asaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel gastritis. Due to persistent abdominal case with our patient. However, low risk KEY WORDS: glomus tumor, gastrointestinal stromal pain, a computerized tomography scan of and unpredictable malignant behavior tumor, benign tumor of stomach the abdomen was performed revealing a cannot be excluded. There are no data on IMAJ 2012; 14: 192 5.9 x 6 cm antral mass. With a tentative the mode of dissemination, and the only diagnosis of a gastric gastrointestinal report of metastatic spread was to the stromal tumor, the patient underwent an liver. Radiographic and endoscopic inves- astric glomus tumors are rare tumors exploratory laparotomy that showed a 5 tigations are not specific in most cases. G of the gastrointestinal tract originat- cm irregular antral mass, and a sub-total Glomus tumors of the stomach can be dif- ing in the neuromyoarterial glomus struc- gastrectomy was performed with an un- ferentiated from gastrointestinal stromal ture. The first case of a gastric glomus eventful postoperative course. tumors, carcinoid tumors, mucosa-asso- tumor was described by Key et al. in 1951 Pathological evaluation showed the ciated lymphoid tissue lymphoma, gastric [1]. Glomus tumors of the stomach are presence of a population of round homo- lymphoma and other types of tumor usually benign, but malignant behavior genous cells with a hemangiopericytoma- based on morphology and immunohis- cannot be excluded. We present a case of like vascular pattern and no significant tochemical studies [2-4]. When there are non-malignant glomus tumor. proliferative activity (< 2 MF/50 HPF) no signs suggestive of malignancy, limited or necrosis along with immunopositivity resection is the treatment of choice, but for muscle-specific actin, alpha-smooth there are no clinical guidelines as to when PATIENT DESCRIPTION muscle actin and calponin. These fea- to perform a limited resection and when A 37 year old otherwise healthy woman tures support the diagnosis of a glomus to perform gastric resection. The largest was admitted with complaints of upper tumor [Figure]. collected series of glomus tumors was middle abdominal pain, dysphagia and a The morphologic differential diagnosis reported by Miettinen et al. [5]. Since the few episodes of melena. Physical examina- is that of an epithelioid gastrointestinal overall number of cases reported is small, tion and blood tests were within normal stromal tumor. However, in this case the there are not enough data to support an limits. An upper gastrointestinal endos- morphology and the immunophenotype active follow-up. copy revealed no abnormality except – PDGFRA-α (negative) and c-kit (nega- Corresponding author: for Helicobacter pylori-positive chronic tive) – did not support this diagnosis. This Dr. A. Halevy kind of tumor is generally associated with Division of Surgery, Asaf Harofeh Medical Center, a good prognosis, especially when atypia Zerifin 70300, Israel Glomus tumor (hematoxylin & eosin, original magnification Phone: (972-8) 997-9222/3 x400). The tumor consists of homogeneous, middle-sized cells and direct angiolymphatic involvement Fax: (972-8) 977-8225 with low proliferative activity are lacking. email: [email protected] References CoMMENT 1. Key S, Callaahn WP, Murray M. Glomus tumor of the stomach. Cancer 1951; 4: 726-36. The glomus body is a specialized form 2. Lee HW, Lee JJ, Yang DH, Lee BH. DH, Lee BH. of arteriovenous anastomosis involved A clinicopathologic study of glomus tumor of the stomach. J Clin Gastroenterol 2006; 40: 717-20. in thermoregulation [1]. Glomus tumors 3. Kapur U, Hobbs CM, McDermott E, Mooney EE. are typically found in peripheral soft tis- Gastric glomus tumor. Ann Diagn Pathol 2004. 8: sues, but have also been found in other 32-5. organs. The majority of gastrointestinal 4. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors glomus tumors are located in the stom- (GISTs): a review. Eur J Cancer 2002; 38 (Suppl 5): ach. Most of these tumors are benign S39-51. and associated with a good prognosis, 5. Miettinen M, Paal E, Lasota J, Sobin LH. Gastro- intestinal glomus tumors: a clinicopathologic, especially when atypia and direct angio- immunohistochemical, and molecular genetic study lymphatic invasion are lacking, as was the of 32 cases. Am J Surg Pathol 2002; 26: 301-11. 192 .