Advantage Care New York New York, NY, United States
Marissa Saltzman, PA1, Eric O. Then, MD2, Yingxian Liu, MD3, Lewis Genuth, MD2, Derrick Cheung, MD3 1Advantage Care New York, New York, NY; 2The Brooklyn Hospital Center, Brooklyn, NY; 3Brooklyn Hospital Center, Brooklyn, NY
Introduction: Glomus tumors (GT) are benign lesions that arise from a dermal glomus body responsible for skin thermoregulation. Though clinically recognized as benign, these tumors can behave like malignant lesions. GT’s rarely involve visceral organs and make up less than 1% of gastrointestinal tumors. The gold standard for treatment of gastric GTs is wide local excision, with no identification of extended margins of resection. We report a case of a slow growing gastric mass (GM) initially diagnosed as a benign GI stromal tumor (GIST) and seven years later, identified as a gastric GT using EUS guided FNB.
Case Description/Methods: A 72-year-old male was hospitalized for an upper GI bleed that was notable for a 1.5 cm bleeding gastric ulcer (BGU). Repeat EGD showed a 2 cm submucosal GM identified whose biopsy was non-diagnostic. It is unclear if this submucosal mass formed at the initial site of the BGU. Patient was offered surgical excision, but declined, and was subsequently lost to follow up. After 7 years, the patient was referred for a positive stool FIT. EGD at this time showed a non-bleeding 3 cm submucosal GM of the antral floor (Fig 1A). Initial biopsy showed mild foveolar hyperplasia. Patient was then referred for EUS, which was notable for a 2.5 x 1.9 cm submucosal antral tumor (Fig 1B). EUS-guided FNB was performed, and pathology identified a GT staining positively to calretinin (Fig 1C), KI-67, vimentin, and synaptophysin. Upon these findings, the patient was again offered surgical resection, but declined.
Discussion: This case highlights the importance of utilizing EUS-guided FNB to accurately diagnose a slow-growing submucosal GM. This patient, initially hospitalized in 2013 with an upper GI bleed, remained asymptomatic for 7 years until he was referred for evaluation of a positive stool FIT. Patient denied all GI symptoms including abdominal pain, nausea, vomiting, change in bowel habits, melena, and unintentional weight loss. Though benign, GTs can follow a malignant growth pattern and may cause symptoms in an otherwise healthy patient. If symptomatic, treatment includes surgical excision, otherwise routine monitoring is not recommended.
Figure: Figure 1A: EGD showing a 3cm sub-mucosal gastric mass located in the antrum. Figure 1B: EUS showing 2.5 x 1.9 cm submucosal antral tumor arising from the muscalris propria layer. Figure 1C: Histopathology showing tumor cells staining positively to calretinin consistent with glomus tumor.
Disclosures:
Marissa Saltzman indicated no relevant financial relationships.
Eric Then indicated no relevant financial relationships.
Yingxian Liu indicated no relevant financial relationships.
Lewis Genuth indicated no relevant financial relationships.
Derrick Cheung indicated no relevant financial relationships.
Marissa Saltzman, PA1, Eric O. Then, MD2, Yingxian Liu, MD3, Lewis Genuth, MD2, Derrick Cheung, MD3. P2050 - Gastric Glomus Tumor: A Rare Presentation of Upper GI Bleed, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
