Gastric glomus tumor with uncertain malignant potential: Case report of a rare cause of occult upper gastrointestinal bleeding

Abstract

Background: Glomus tumors (GTs) are mesenchymal neoplasms that are typically benign. Gastric GTs are uncommon and occur mostly in the upper gastrointestinal tract. Malignant gastric GTs are exceedingly rare, constituting fewer than 1% of gastric tumors. Because their features are similar to those of other tumors found in the same gastrointestinal region, such as stromal tumors, leiomyomas, lymphomas, and lipomas, diagnosis is challenging. Case Presentation: A 52-year-old male patient presented with fatigue and melena. Initial endoscopic examinations failed to locate any source of bleeding. Six months later, pan-gastroscopy, performed because of progressive microcytic anemia, revealed a 40 ´ 30 mm polypoid lesion with deep ulcerations; histopathological analysis confirmed that it was a gastric GT with alpha-actin and cadherin 17 expression and a Ki-67 index of 20%. The patient delayed surgical therapy until his symptoms worsened. Laparoscopic sleeve resection revealed a 65 ´ 45 ´25 mm tumor, and secondary immunohistochemical analysis revealed extensive spread into the mucosa and subserosa. Focally, the tumor bulged into some large veins. Genetic examination with RNA isolation further supported the histopathological diagnosis of gastric GT with uncertain malignant potential. Conclusions: This case underscores the diagnostic challenges posed by gastric GTs because they are rare and their clinical features are similar to those of other gastric tumors. Thorough histopathological and molecular analysis are essential for accurate diagnosis. Surgical intervention remains the primary therapeutic approach. This case also emphasizes the need for long-term followup because of the potential for recurrence and for malignancy.