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ATYPICAL PRESENTATION OF GASTRIC PLEXIFORM FIBROMYXOMA MASQUERADING AS A GASTRIC NODULE: A CASE REPORT
Simar Goyal
*1, Sourodip Mukharjee
2, Kumaran Mudaliar
3, Joshua Kong
2, juan malo
2, Joseph Buell
2, Houssam Osman
2, D Rohan Jeyarajah
21Texas Christian University Anne Burnett Marion School of Medicine, Fort Worth, TX; 2Methodist Richardson Medical Center, Richardson, TX; 3Methodist Dallas Medical Center, Dallas, TX
Introduction:
Gastric plexiform fibromyxoma is a rare, benign mesenchymal tumor that primarily occurs in the antrum of the stomach. Due to its rarity, the pathogenesis and treatment protocols are largely unknown. In this case report, we present a gastric plexiform fibromyxoma in a patient with non-specific symptoms.
Case presentation:
A 48-year-old female, with a past medical history of anxiety and exocrine pancreatic insufficiency, presented to a surgical clinic for further evaluation of a gastric nodule found on endoscopy. She experienced a lack of appetite, early satiety, persistent nausea without vomiting, and weight loss for four years prior to presentation. The patient was diagnosed with exocrine pancreatic insufficiency at the onset of symptoms, but treatment did not resolve her symptoms. However, esophagogastroduodenoscopy (EGD) and subsequent DOTATATE PET scan noted a 6.5x7.3 mm nodule in the body of the stomach. The nodule was presumed to be neuroendocrine in origin due to DOTATATE avidity. After discussion of alternative options, the patient elected for resection of the mass.
Results:
The patient was taken to the operating room, and a laparoscopic partial gastrectomy with intraoperative EGD was performed for intra-operational localization. The lesion was found in the anterior mid-body of the stomach, and en bloc resection was achieved. She was discharged on postoperative day 2. Postoperatively, the pathology results revealed that the mass was a benign spindle cell lesion with myxoid stroma and rich, delicate vasculature suggestive of plexiform fibromyoma (Figures 1a and 1b). The ki67 proliferative index was low; IHC markers were positive for SMA and CD117 and negative for EMA, beta-catenin, CD34, and DOG-1. At her two-month post-operative visit, the patient reported a resolution of gastrointestinal symptoms. She was advised to have a yearly EGD and follow-ups in the office every 6 months.
Conclusion:
Plexiform fibromyoma is an extremely rare tumor that is likely under-recognized. Given its low incidence, there are no set guidelines for monitoring and managing this condition. Based on our review of prior case reports, we propose that patients undergo yearly EGDs and close follow-ups due to the potential risk of recurrence.
Figure 1a
Figure 1b
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