PMC4276278_01
CT scan of the abdomen and pelvis with IV contrast showing 2.5 cm x 2 cm hyperdense gastric lesion suggesting intramural tumor. (A) Axial cuts (B) coronal cuts.
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A computed tomography (CT) scan of the abdomen and pelvis showed a 2.5 cm x 2 cm hyperdense gastric lesion (Fig. 1).
(A) Round submucosal lesion noted at the pylorus. (B) Endoscopic ultrasonogrophy (EUS) shows1.7 cm x 2.5 cm slightly hyperechoic round lesion arising from the muscularis propria.
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Upper GI endoscopy and Endoscopic ultrasound (EUS) confirmed the presence of a submucosal antral mass along the greater curvature, suspicious for a GIST, hence a preoperative biopsy was not performed (Fig. 2).
Laparoscopic resection of the tumor at the antrum using staples, hand sewn anastomsis with Billroth I reconstuction.
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Billroth I reconstruction was performed because the mass was relatively large in size for wedge resection. Billroth I was preferred because tumors in certain parts of the stomach may require Billroth I or II to preclude any primary closure and to achieve gastrointestinal continuity (Fig. 3).
Gross pathology of the tumor showing intramural lesion.
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Gross examination demonstrated a 2 x 1.6 x 1.6-cm submucosal and well-circumscribed mass (Fig. 4) and histology revealed a tumor consisting of a proliferation of round and extremely uniform cells arranged around vascular spaces of varying sizes.
Trabeculae of tumor cells distributed next to the stomach's muscularis propria (Hematoxylin and Eosin stain 100x).
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Immunohistochemistry confirmed that the mass stained strongly positive for smooth muscle actin (SMA), weakly positive for synaptophysin, and was negative for chromogranin and cytokeratin establishing the diagnosis of glomus tumor of the gastric antrum (Figs. 5, 6).
Glomus tumor of the stomach (smooth muscle actin (SMA) stain that is strongly positive in glomus cells and in the smooth muscle of the muscularis propria 100x).
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Immunohistochemistry confirmed that the mass stained strongly positive for smooth muscle actin (SMA), weakly positive for synaptophysin, and was negative for chromogranin and cytokeratin establishing the diagnosis of glomus tumor of the gastric antrum (Figs. 5, 6).