Cytopathologic diagnosis of esophageal glomus tumor presenting as an incidental posterior mediastinal mass in an 80‐year‐old male

Abstract

Endoscopic ultrasound guided fine-needle aspiration (FNA) of the upper gastrointestinal tract presents a diagnostic challenge to cytopathologists due to the broad differential diagnosis and morphologic overlap between various entities in this location. We report here an incidentally discovered case of esophageal glomus tumor presenting as a posterior mediastinal mass in an 80-year old male. Glomus tumor is a rare soft tissue neoplasm with bland epithelioid morphology and cytoplasmic granularity. Literature review reveals only 6 published cases of esophageal glomus tumor in the general pathology literature. To our knowledge, this is the first report in the English literature to describe FNA cytology of an esophageal glomus tumor. This rare case presentation provides the opportunity to review the differential diagnosis for lesions of the upper gastrointestinal tract and their appearance on FNA in order to clarify an entity that is uncommon in everyday cytology practice.

Malignant glomus tumor with oncocytic features: an unusual presentation of dysphagia

“…Among the case reports of glomus tumor in the esophagus within the literature, all patients have been positive for SMA and vimentin and negative for CD117 (cKIT), S-100, and HMB45 (8)(9)(10)(11)(12)(13)(14). In two cases using Ki67, the proliferation indices were 10% and 5%, respectively (13,15).…”

“…Miettinen (5) reviewed 32 cases of glomus tumors in the gastrointestinal tract, most of which were located in the stomach (n:31) and intestines (n:1). Fewer than 10 cases of glomus tumors in the esophagus have been described in the literature (11)(12)(13)(14)(15)(16)(17).…”

“…In the literature of case reports describing glomus tumors located at the esophagus, the patients consisted of four women and three men, ranging in age from 28 to 80 years (mean, 56 years) (11)(12)(13)(14)(15)(16)(17). The clinicopathologic findings of these cases are summarized in Table 1.…”

“…The full text of these seven case reports accounts for five patients, with two assumed to have also benefited based on the abstract. Three patients presented with dysphagia and weight loss; whereas, the remaining four patients were detected during an incidental endoscopy (11)(12)(13)(14)(15)(16)(17). In one case, emesis, regurgitation, and bloody stool were present in addition to dysphagia and weight loss (15).…”

“…If all of the cases in the literature are considered, presenting symptoms occurred when the tumor diameter rose above 30 mm. Nuclear atypia was present in four cases, and the mitotic activity was between 0 to 10/50 HPF (11)(12)(13)(14)(15)(16)(17). One patient had lymph node metastasis; in this case, the diameter of the tumor was 58 mm, and the mitotic activity was 10/50 HPF (13).…”