Gastric Glomus Tumor Diagnosed on Upper Endoscopy: A Case Report

Introduction: Gastric glomus tumors are benign tumors that result from cells of the glomus body and typically occur in the submucosa of the gastric wall. Collectively, glomus tumors are rare entities that rarely manifest in the stomach. Diagnosis is challenging as the tumors lack specific clinical features, radiographic findings, and endoscopic findings. Case Description/Methods: A 44-year-old female with a past medical history of multiple sclerosis, chronic constipation, and depression presents to gastroenterology clinic for evaluation of abdominal pain. Her pain is in the bilateral lower quadrants, worsened over the course of three months, and is associated with intermittent nausea. Physical exam and serologic workup were normal. She was started on fiber and laxatives for treatment of constipation. However, in light of no improvement with these measures, the decision was made to proceed with esophagogastroduodenoscopy (EGD). Her EGD revealed a 1.5 centimeter umbilicated gastric tumor located in the greater curvature of the stomach with a shallow ulcer on top of it that was oozing blood (Figure 1). Grossly, this lesion was initially thought to represent a gastrointestinal stromal tumor (GIST) and biopsies were obtained. However, pathology was most consistent with a gastric glomus tumor (GGT). A follow-up computed tomography scan showed a 2.2 x 1.8 x 2.0 cm submucosal, mixed density, well-circumscribed mass along the greater curvature of the stomach. She was referred to the surgery team and underwent partial laparoscopic gastrectomy with complete resection of the tumor. Discussion: Glomus tumors typically develop in the upper extremities and have a predilection for the subungual region of the finger. Glomus tumors can also develop in the gastrointestinal tract, with the submucosal region of the stomach representing the most common gastrointestinal location. Overall, GGTs represent less than one percent of all soft tissue gastric tumors with GISTs being the most common. Our case highlights two important points: first, our patient was accurately diagnosed by EGD with conventional biopsy. This was likely due in part to the growth pattern of this patient’s tumor into the gastric cavity. Thus, an adequate specimen was obtained by conventional biopsy despite the intramural nature of the tumor because part of the tumor was exposed to the lumen. Second, the ulcerated and umbilicated appearance of the tumor also emphasizes the need to include such an entity in the differential diagnosis of gastric tumors.Figure 1.: A. Endoscopic image of thickened prepyloric fold from first EGD B. H&E stain demonstrating signet ring cell carcinoma from first gastric biopsy.