A Rare Cause of Massive Upper GI Bleeding in a Young Adult: Gastric Cavernous Hemangioma Mimicking GIST

Abstract

Gastric hemangiomas are exceedingly rare benign vascular tumors, representing less than 0.05% of all gastrointestinal neoplasms and often misdiagnosed as submucosal tumors like gastrointestinal stromal tumors (GISTs). We present a case of a 33-year-old woman who arrived with acute upper gastrointestinal bleeding, presenting as multiple episodes of coffee-ground emesis and signs of hypovolemia. Imaging identified a hyperenhancing lesion in the gastric fundus with active contrast extravasation. Endoscopic evaluation revealed a friable submucosal lesion with central ulceration, initially suspected to be a GIST. Due to bleeding risk, biopsies were inconclusive, and an elevated chromogranin A level further complicated the diagnosis. The patient underwent a laparoscopic-assisted partial gastrectomy for definitive diagnosis and treatment. Histopathological analysis confirmed a benign cavernous hemangioma involving the mucosa and muscularis propria, with negative margins and no malignant features. The patient recovered uneventfully postoperatively. This case emphasizes the diagnostic challenges of gastric hemangiomas, especially when imaging and endoscopic findings mimic more common neoplasms. Surgical resection remains the cornerstone for both diagnosis and management, particularly in cases where biopsy is unsafe or inconclusive. Early recognition and a multidisciplinary approach are critical for optimal outcomes in such rare presentations.