Diagnostic Challenge of Gastric Glomangioma Mimicking Gastrointestinal Stromal Tumor: A Case Report
Abstract
Introduction
Gastric glomus tumors (GGTs) are rare benign mesenchymal neoplasms of the stomach, often mistaken preoperatively for more common submucosal lesions such as gastrointestinal stromal tumors (GISTs). Accurate diagnosis requires a combination of endoscopic ultrasonography, histopathology, and immunohistochemistry.
Case Description
We report a 51-year-old female with a two-year history of epigastric burning, anorexia, and unexplained weight loss. Initial evaluation included EUS, which identified a 1.8 × 2.4 cm hypoechoic submucosal lesion arising from the muscularis propria at the gastric antrum. Contrast-enhanced CT demonstrated a 2 cm avidly enhancing antral lesion with persistent venous-phase enhancement; no evidence of lymphadenopathy or metastasis was noted. Subsequent EUS-guided fine-needle biopsy (FNB) demonstrated an epithelioid neoplasm. Initial immunohistochemistry excluded GIST (CD117−, DOG1−), leiomyoma (desmin−), and schwannoma (S100−). Additional glomus tumor-specific markers were not performed at this stage due to limited biopsy material and a stepwise diagnostic approach. Given the peri-pancreatic location, diagnostic uncertainty, and lesion size exceeding 2 cm, the decision was made to proceed with laparoscopic distal gastrectomy. Final histopathology confirmed glomangioma, positive for SMA and vimentin; Ki-67 ~1%; 0 mitoses per 50 high-power fields (HPF); no atypia, necrosis, lymphovascular invasion, or clear margins. Postoperative surveillance CTs showed no recurrence; no adjuvant therapy was indicated.
Conclusion
This case highlights the clinical and radiologic overlap between GGT and other submucosal gastric lesions. Comprehensive immunohistochemistry and careful surgical planning are essential for accurate diagnosis and management.
© 2026 Muhammad Imran, Sameen Bin Naeem, Nahel Chaudhry, Saad Ehsan, Muhammad Awais Majeed, published by Shakuat Khanum Memorial Cancer Hospital and Research Centre
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