Morte Douglas, Bingham Jason, Sohn Vance
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431-1100, USA.
Case Rep Gastrointest Med. 2018 May 13;2018:7961981. doi: 10.1155/2018/7961981. eCollection 2018.
Glomus tumors are uncommon mesenchymal neoplasms originating from modified smooth muscle cells in the glomus body. They are generally small, solitary lesions found in the distal extremities. Rarely, involvement in the abdominal viscera can occur. In such cases, hematemesis/melena and epigastric discomfort are the most common initial symptoms. Although gastric glomus tumors can demonstrate malignant behavior, criteria for identifying malignant potential have yet to be established.
We present a rare case of gastric glomus tumor in an otherwise healthy 41-year-old female. The patient initially presented with a significant upper GI bleed requiring a 4 U PRBC transfusion for stabilization. An upper endoscopy with endoscopic ultrasound identified an ulcerated, submucosal mass thought to be consistent with GI stromal tumor (GIST). Once clinically stable, she was scheduled for elective resection. However, prior to resection she experienced a second hemodynamically significant upper GI bleed and underwent emergent laparotomy with distal gastrectomy. Pathologic examination revealed a 3 cm glomus tumor.
Gastric glomus tumors are rare solitary submucosal tumors for which preoperative diagnosis is challenging and can be confused with a GIST. Local resection with negative margins is the preferred treatment and the exact diagnosis relies heavily on histopathological examinations. Currently, there are no clear guidelines regarding the staging and malignant potential of glomus tumors of the stomach.
血管球瘤是一种罕见的间叶组织肿瘤，起源于血管球体内经修饰的平滑肌细胞。它们通常较小，为孤立性病变，多见于四肢远端。极少情况下可累及腹腔脏器。在此类病例中，呕血/黑便和上腹部不适是最常见的初始症状。尽管胃血管球瘤可表现出恶性行为，但识别其恶性潜能的标准尚未确立。
我们报告一例罕见的胃血管球瘤病例，患者为一名41岁健康女性。患者最初因严重上消化道出血就诊，需要输注4单位浓缩红细胞以稳定病情。上消化道内镜检查及内镜超声检查发现一个溃疡样黏膜下肿物，考虑与胃肠道间质瘤（GIST）相符。病情稳定后，她被安排择期手术切除。然而，在手术切除前，她再次发生了一次具有血流动力学意义的上消化道大出血，并接受了急诊剖腹手术及远端胃切除术。病理检查显示为一个3厘米的血管球瘤。
胃血管球瘤是罕见的孤立性黏膜下肿瘤，术前诊断具有挑战性，且可能与GIST混淆。切缘阴性的局部切除是首选治疗方法，准确诊断很大程度上依赖于组织病理学检查。目前，关于胃血管球瘤的分期及恶性潜能尚无明确指南。
