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15 October 2014 - Case of the Week #330

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Case of the Week #330

Clinical History:
A 72 year old woman with hematemesis had an upper digestive endoscopy, which revealed a 5 cm nodular submucosal lesion localized on the antrum. A partial gastrectomy was performed.

Endoscopy image:

Micro images:

What is your diagnosis?

Plexiform fibromyxoma of the gastric antrum


Actin (left); caldesmon (right)

Histology shows a proliferation of cytologically bland spindle cells with a myxoid background. Immunohistochemistry shows diffuse positivity for smooth muscle actin and focal positivity for CD10 and caldesmon. Stains for desmin, S100, CD34, C-kit and DOG1 were negative.

This case also tests your memory of prior cases of the week. Apparently, ours is not so good, as a case with the same diagnosis was previously described in Case #316 in June 2014, and we try to avoid posting new cases with a similar diagnosis as a prior case. Gastric plexiform fibromyxoma is a rare benign tumor, specific to the stomach, recently added to the WHO Classification of Tumours of the Digestive System (IARC, 2010). It is also known as plexiform angiomyxoid myofibroblastic tumor (Am J Surg Pathol 2007;31:724, Am J Surg Pathol 2009;33:1624). More information is posted as part of Case #316.

Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com