Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2253-2260
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2253
Huge gastric plexiform fibromyxoma presenting as pyemia by rupture of tumor: A case report
Rui Zhang, Li-Gang Xia, Kai-Bin Huang, Nan-Di Chen
Rui Zhang, Li-Gang Xia, Kai-Bin Huang, Nan-Di Chen, The Second Clinical Medical College, Shenzhen People’s Hospital, Jinan University, Shenzhen 518020, Guangdong Province, China
Author contributions: Zhang R designed the report and drafted the manuscript; Huang KB and Chen ND collected patient’s clinical data; Xia LG worked with the pathologists in our hospital to determine the pathological diagnosis after thorough discussion; Xia LG analyzed the data and provided recommendations for the manuscript; and all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Gang Xia, Doctor, MD, Adjunct Professor, Chief Doctor, The second Clinical Medical College, Shenzhen People’s Hospital, Jinan University, No. 1017, Dongmen North Road, Luohu District, Shenzhen 518020, Guangdong Province, China. rmyyxlg@163.com
Received: August 9, 2021
Peer-review started: August 9, 2021
First decision: October 17, 2021
Revised: October 25, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 6, 2022
Processing time: 204 Days and 14.4 Hours
Abstract
BACKGROUND

Plexiform fibromyxoma (PF) is a rare mesenchymal tumor, with limited case reports worldwide. Common clinical symptoms are abdominal discomfort and bleeding signs, which frequently present slow-onset in reported cases. Herein, we report a case of gastric PF presenting as acute onset and with pyemia accom-panying tumor rupture. We resected the tumor as well as the distal gastric, bulbus duodeni and gallbladder for treatment in emergency surgery. Notably, before the onset of the disease, the patient received coronavirus disease 2019 (COVID-19) vaccines.

CASE SUMMARY

A 26-year-old man was admitted to our hospital, due to abdominal pain and fever after having received COVID-19 vaccines. Laboratory examination indicated severe sepsis. Computed tomography scan revealed a large mass in the abdomen. Deformation of the gastrointestinal tract was seen during gastroscopy. After failure of anti-infective treatment and symptoms of shock developed, he received an emergency surgery. We found a huge and partly ruptured mass, with thick purulence. Microscopically, the mass was composed of spindle cells with clarified cytoplasm, accompanied by myxoid stroma and arborizing blood vessels. Immunohistochemistry showed the tumor cells as positive for smooth muscle actin and succinate dehydrogenase subunit B but negative for DOG-1 and CD117. Finally, the patient was diagnosed with gastric PF and discharged from the hospital.

CONCLUSION

Gastric PF manifesting as tumor rupture combined with pyemia is rare. Timely surgery is critical for optimal prognosis.

Keywords: Gastric plexiform fibromyxoma; Clinical manifestations; Sepsis; Emergency surgery; Pathology; COVID-19 vaccines; Case report

Core Tip: Gastric plexiform fibromyxoma (PF) is a rare mesenchymal tumor, with limited reports worldwide. This may be the first case report worldwide of emergency surgery performed for ruptured gastric PF with severe infection, demonstrating the rarity of the symptoms of this disease. In addition, we noted that the patient had a history of coronavirus disease 2019 vaccination before the onset of the disease. We also conducted a database search of PubMed and Web of Science as of June 2021, determining the number of reported cases to be 134 worldwide. Some new cases and experiences are summarized in this report.