Laparoscopic resection of a gastric glomangioma

A 51-year-old woman underwent gastroscopy because of epigastric distension. The mucosa in the lesser curvature of the distal gastric body showed a hemispheric bulge, with a smooth surface and normal color ([Fig. 1]). An ultrasound scan showed the presence of a lesion located within the submucosa. It was olive shaped with a medium echo, and the boundary was distinct and smooth with uneven echoes. Multiple hypoechoic lumen-like structures, which typically measured approximately 2 mm, were observed inside the lesion. Color Doppler showed a rich blood flow inside these lumen-like structures ([Fig. 2]).

Fig. 1 Endoscopic appearance in a 51-year-old woman with epigastric distension showing a hemispheric bulge in the mucosa of the lesser curvature of the distal gastric body.

Fig. 2 Color Doppler ultrasound view of the lesion showing rich blood flow within the multiple hypoechoic lumen-like structures that were identified in the lesion.

A preliminary diagnosis of gastric hemangioma was made and a laparoscopic wedge resection was performed ([Fig. 3]). Subsequent pathologic examination showed lesions in the submucosa and between the muscles that were consistent with glomangioma ([Fig. 4]). Immunohistochemical staining was negative with CD117, CD34, DOG.1, S-100, CgA, p53, and AE1 /AE3; weakly positive with Vimentin ([Fig. 5]) and Syn; moderately positive with SMA; and Ki-67 revealed 5 % – 10 % positivity.

Fig. 3 Appearance during laparoscopic wedge resection of the gastric hemangioma.

Fig. 4 Pathologic appearance of the wedge resection specimen showing lesions located in the submucosa and between the muscles, which were consistent with a glomangioma.

Fig. 5 Immunohistochemical staining of the wedge resection specimen showing positivity for Vimentin.

Gastric glomangioma is a rare benign gastric tumor. Most patients show no symptoms, but some do have gastrointestinal bleeding. One of the 32 cases reported by Miettinen et al. showed invasive biologic behavior [1]. In our case, the capsule remained intact after resection and the cells showed no atypical morphology; no recurrence or metastases have occurred within a year of follow-up.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AF

• References

• 1 Miettinen M, Paal E, Lasota J et al. Gastrointestinal glomus tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 32 cases. Am J Surg Pathol 2002; 26: 301-311