S6420 A Rare Case of Gastric Angiomyolipoma Presenting With Vague Abdominal Pain

Introduction: Angiomyolipoma (AML) is a mesenchymal neoplasm and a member of the perivascular epithelioid cell tumor 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 man 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 esophagogastroduodenoscopy (EGD) revealed no abnormalities. Recent EGD identified a 4 × 10 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.