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Malignant Glomus Tumor of the Lung With Multiorgan Metastases: Case Report and Literature Review FREE TO VIEW

Liang Dong, MD; Jing Ying, MD; Guo Chen, MD
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Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A269. doi:10.1016/j.chest.2016.02.281
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: The most common location of glomus tumorsis the distal extremities. Primary pulmonary glomus tumors are extremely rare. Although predominantly benign, rarely glomus tumors may demonstrate aggressive features2. 23 primary pulmonary glomus tumors have been reported, with 7cases displaying malignant characteristics only 1 case exhibits widespread metastasis.1 We report a case of malignant glomus tumor (MGT) of the lung with metastases to gastrointestinal tract, spleen and adrenal gland.

CASE PRESENTATION: A 60-year-old female patient presented to us complaining of cough for 3 months. Physical examination reveal no significant findings. CT revealed a 2.5x1.5cm broad based enhancement at lingual segment (1A, B). Bronchoscopy revealed a white polypoid tumor occupying left lingular bronchus (1E). Biopsy was sent for pathology which revealed inflammatory exudates. Two months later the patient presented again to us with worsening of her symptoms. Another bronchoscopy showed the same white polypoid tumor with protrusion into the left main bronchus (1F). The tumor was excised by high-frequency electric snare ligation and sent for pathological examination. An abdominal CTdemonstrated multiple mass-like lesions occupying the gastrointestinal cavity, spleen and left adrenal gland (1C, D). An upper endoscopy was performed with ligation of mass-lesions in the fundus, antrum and duodenum (1G, H). Pathology ofthe specimens revealed uniform polygonal cells with nuclear atypia, necrosis andmitotic activity. IHC of the biopsy specimens stained positive for SMA and vimentin (2), and was partially positive for CD99and F8. The staining patterns supported the diagnosis of MGT. Finally, the symptoms worsened with massive hemoptysis and gastrointestinal bleeding. The patient died of multiorgan failure.

DISCUSSION: From the literature review and as seen in our patient, glomus tumors have the potential to be aggressive. Close follow-up is strongly advocated due to the risk of metastasis. Our patient presented with pulmonary and stomach lesions that had similar cytological and immunohistochemical findings. The question arises as to the origin of the primary tumor. There is little known of specific immunohistochemical markers used to distinguish primary from secondary MGT. At first, our patient complained of pulmonary symptoms without any abdominal disturbance. Bronchoscopy revealed a mass occupying the left lingular bronchus, which is not often seen in metastatic lung tumors. Also, the radiographic findings were not consistent with metastatic lung cancer.

CONCLUSIONS: MGT of lung are rare, metastasis is even rarer. Careful histological observation and immunostaining for appropriate markers are essential in the diagnosis of MGT. It is difficult to accurately predict metastasis and prognosis of MGT. Therefore, close follow up of patients is imperative.

Reference #1: 1 Zhang Q, et al. Malignant glomus tumour of the lung. Pathology. 2010:594-596

Reference #2: 2 Gombos Z. Glomus tumor. Arch Pathol Lab Med. 2008:1448-1452

DISCLOSURE: The following authors have nothing to disclose: Liang Dong, Jing Ying, Guo Chen

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