A 67-year-old woman presented with a 3-month history of upper abdominal pain. No positive
result was found in tumor markers and antinuclear antibodies. Magnetic resonance imaging
(MRI) detected a 15 × 11-mm mass with a T1W low signal and T2W high signal, which
was enhanced in the arterial phase and weakened in the delayed phase. Endoscopic ultrasound
(EUS) revealed a 14 × 12-mm hypoechoic lesion with a heterogeneous echo and a few
stripe hyperechoic tissues. Ultrasound elastography imaging was primarily dominated
by yellow-green tones interspersed with small areas of red and blue hues. Contrast-enhanced
ultrasound showed heterogeneous enhancement in the arterial phase that receded quickly
in the venous phase. The specimens were obtained by EUS-guided fine needle aspiration
(FNA) with a 22G puncture needle of wet suction. Pathological examination revealed
round tumor cells with SMA(+), Syn(–), Ki67 (3%+), CD34 (vascular+), consistent with
the characteristics of a glomangiomyoma ([Fig. 1]).
Fig. 1 Pathological examination: glomangiomyoma. a Hematoxylin-eosin: round tumor cells. b SMA(+). c CD34(vascular+).
Glomangiomyoma is a rare benign tumor of the glomus body, a specialized form of arteriovenous
anastomosis. This case demonstrated the first comprehensive diagnosis procedure for
pancreas glomangiomyoma by EUS-FNA. Pancreatic glomangioma was only reported by John
R Miliauskas et al. in 2002 [1] and Ichiro Tamaki et al. in 2020 [2], which were all diagnosed by surgery. This case showed a well-defined, round-like
mass under EUS scanning, and high enhancement under contrast-enhanced ultrasound,
similar to neuroendocrine tumors. However, its internal echo was uneven, and under
ultrasound elastography imaging, it showed an inhomogeneous soft tissue, whose hardness
was lower than most neuroendocrine tumors. Under contrast-enhanced ultrasound, it
showed an uneven high enhancement different from the uniform high enhancement of most
neuroendocrine tumors. These characteristics might be helpful in differentiating pancreatic
hemangiomas from neuroendocrine tumors. EUS-FNA is a reliable and practical technique
for diagnosing pancreatic glomus tumors ([Video 1]).
Clinical manifestation of a rare pancreatic glomangiomyoma.Video 1
Endoscopy_UCTN_Code_CCL_1AF_2AZ_3AB
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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