Hansen T, Titze U, Trachte F, Maschuw K, Hiller W, Tebbe J J
Institut für Pathologie, Klinikum Lippe GmbH, Röntgenstraße 18, 32756, Detmold, Deutschland.
Klinik für Gastroenterologie und Infektiologie, Klinikum Lippe GmbH, Detmold, Deutschland.
Pathologe. 2021 May;42(3):328-332. doi: 10.1007/s00292-020-00886-6. Epub 2020 Dec 23.
We report on a 72-year-old male patient suffering from weight loss, diarrhea, and epigastric pain. By means of endosonographic ultrasound, a well-circumscribed tumor mass was found in the gastric wall, suggesting a gastrointestinal stromal tumor (GIST). Biopsies were taken and processed for standard histopathological analysis. The microscopy revealed uniform, small, round cells with central nuclei and prominent cell borders embedded in vascularized stroma. Immunohistochemistry demonstrated the expression of actin, but showed negativity for cytokeratin, CD34, CD117, DOG‑1, desmin, and CD45. The tumor was diagnosed as a gastral glomus tumor. The diagnosis was confirmed in the wedge resection specimen. Gastral glomus tumors are rare intramural tumors of the stomach. GIST and neuroendocrine tumor (NET) present the main differential diagnoses. Especially with regard to the epithelioid variant of GIST, clear separation can be difficult. Besides standard histological examination, immunohistochemistry and molecular analysis can be helpful since gastral glomus tumors do not obtain c‑Kit- or PDGFRα mutations. Based on the fact that this tumor most commonly shows a benign biological behavior, the prognosis of gastral glomus tumors is favorable.
我们报告了一名72岁男性患者，他患有体重减轻、腹泻和上腹部疼痛。通过内镜超声检查，在胃壁发现了一个边界清晰的肿瘤肿块，提示为胃肠道间质瘤（GIST）。进行活检并进行标准组织病理学分析。显微镜检查显示，肿瘤细胞均匀、小而圆，细胞核位于中央，细胞边界突出，包埋于血管化的间质中。免疫组织化学显示肌动蛋白表达阳性，但细胞角蛋白、CD34、CD117、DOG-1、结蛋白和CD45表达阴性。该肿瘤被诊断为胃血管球瘤。楔形切除标本的诊断得到了证实。胃血管球瘤是胃罕见的壁内肿瘤。GIST和神经内分泌肿瘤（NET）是主要的鉴别诊断对象。特别是对于GIST的上皮样变型，可能难以明确区分。除了标准组织学检查外，免疫组织化学和分子分析可能会有帮助，因为胃血管球瘤不会发生c-Kit或PDGFRα突变。基于这种肿瘤最常表现为良性生物学行为这一事实，胃血管球瘤的预后良好。
