Gastric Glomus Tumor: An Uncommon Source for an Acute Upper GI Bleed

BACKGROUND: Glomus tumors are uncommon mesenchymal neoplasms originating from modified smooth muscle cells in the glomus body. They are generally small, solitary lesions found in the distal extremities. Rarely, involvement in the abdominal viscera can occur. In such cases, hematemesis/melena and epigastric discomfort are the most common initial symptoms. Although gastric glomus tumors can demonstrate malignant behavior, criteria for identifying malignant potential have yet to be established. CASE PRESENTATION: We present a rare case of gastric glomus tumor in an otherwise healthy 41-year-old female. The patient initially presented with a significant upper GI bleed requiring a 4 U PRBC transfusion for stabilization. An upper endoscopy with endoscopic ultrasound identified an ulcerated, submucosal mass thought to be consistent with GI stromal tumor (GIST). Once clinically stable, she was scheduled for elective resection. However, prior to resection she experienced a second hemodynamically significant upper GI bleed and underwent emergent laparotomy with distal gastrectomy. Pathologic examination revealed a 3 cm glomus tumor. CONCLUSION: Gastric glomus tumors are rare solitary submucosal tumors for which preoperative diagnosis is challenging and can be confused with a GIST. Local resection with negative margins is the preferred treatment and the exact diagnosis relies heavily on histopathological examinations. Currently, there are no clear guidelines regarding the staging and malignant potential of glomus tumors of the stomach.