Handa Yoshinori, Kano Mikihiro, Kaneko Mayumi, Hirabayashi Naoki
Department of Surgery, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
Department of Pathology, Hiroshima City Asa Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
Case Rep Surg. 2015;2015:193684. doi: 10.1155/2015/193684. Epub 2015 Dec 1.
A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.
一名24岁女性因黑便被转诊至我科。这些症状与严重贫血促使我们进行急诊上消化道内镜检查，结果显示胃窦部一个30毫米的溃疡性黏膜下肿瘤出血。计算机断层扫描显示一个均匀强化的肿块，内镜超声检查确定胃壁第三和第四层有一个边界清晰的肿块。由于对可能的病因分析尚无定论，且存在再次出血的风险，在输注10单位红细胞浓缩液后进行了腹腔镜辅助胃楔形切除术。组织学和免疫组织学分析显示该肿瘤为胃球瘤。胃黏膜下肿瘤术前诊断仍具有挑战性，因为它们表现出多种放射学和临床病理特征，并且如胃黏膜下肿瘤指南所述，活检时有出血风险。胃球瘤的特征是出现大量胃肠道出血，常需要输血。此外，胃黏膜下肿瘤通常发生在老年患者中；然而，本例患者为一名24岁的年轻患者。在此，我们描述该病例，以确定可能有助于早期鉴别胃黏膜下肿瘤的特征。
