P6345 - A Rare Case of Gastric Angiomyolipoma Presenting With Vague Abdominal Pain

Ammar Ismail, MD¹, Amira Alnakeb, MD², Saba Altarawneh, MD³, Youssef Botros, MD⁴, Robert Spira, MD³
1Jersey City Medical Center, Bayonne, NJ; 2Mansoura University, Bayonne, NJ; 3Jersey City Medical Center, Jersey City, NJ; 4Englewood Hospital and Medical Center, Englewood, NJ

Introduction: Angiomyolipoma (AML) is a mesenchymal neoplasm and a member of the PEComa family, typically arising in perivascular spaces. While renal AML is common, extrarenal occurrences are rare and often discovered incidentally. Gastric AML is exceedingly uncommon, with most reported cases presenting with upper gastrointestinal bleeding (e.g., hematemesis or melena). We describe a unique case of gastric AML in a patient with nonspecific symptoms, expanding the clinical spectrum of this rare entity.

Case Description/

Methods: A 73-year-old male presented with a multi-year history of intermittent nausea and postprandial epigastric pain, without weight loss or bleeding. His medical history included a hiatal hernia, and prior EGD revealed no abnormalities. Recent EGD identified a 4x10 mm submucosal nodule in the gastric antrum. Endoscopic ultrasound (EUS) showed a hyperechoic, well-demarcated lesion originating from the submucosa, with no invasive features. The nodule was completely excised, and histopathology confirmed a benign, encapsulated lipomatous tumor (gastric AML). Post-procedurally, the patient reported symptom resolution.

Discussion: Benign gastric neoplasms are typically epithelial (e.g., hyperplastic polyps) or submucosal (e.g., leiomyomas). Gastric AML, a rare submucosal lesion, has been historically associated with bleeding. Our case contrasts with prior reports, as the patient presented with nonspecific symptoms and no bleeding. This highlights the diagnostic challenge of gastric AML and underscores the role of EUS-guided resection for both diagnosis and treatment. Further studies are needed to elucidate the full clinical and pathological spectrum of this rare tumor.


Figure: Gastric antral lesion before and after endoscopic resection


Figure: Endoscopic Ultrasound showing well circumscribed submucosal lesion

Disclosures:
Ammar Ismail indicated no relevant financial relationships.
Amira Alnakeb indicated no relevant financial relationships.
Saba Altarawneh indicated no relevant financial relationships.
Youssef Botros indicated no relevant financial relationships.
Robert Spira indicated no relevant financial relationships.

Ammar Ismail, MD¹, Amira Alnakeb, MD², Saba Altarawneh, MD³, Youssef Botros, MD⁴, Robert Spira, MD³. P6345 - A Rare Case of Gastric Angiomyolipoma Presenting With Vague Abdominal Pain, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.