Clinical pathological cases in gastroenterology: Stomach

INTRODUCTION — The following cases are meant to illustrate clinical, pathological, and endoscopic findings in patients with a variety of gastric conditions. Detailed discussions on the specific disorders are presented on corresponding topic reviews.

CARCINOID — A 70-year-old man underwent an upper endoscopy for the evaluation of a two day history of melena and new onset dizziness. The patient's only medical problem is rheumatoid arthritis treated with ibuprofen over the past three years. His weight has been stable and he denies having fevers, nausea, vomiting, abdominal pain, or hematochezia. An upper endoscopy revealed the following (picture 1 and picture 2). (See "Clinical characteristics of well-differentiated neuroendocrine (carcinoid) tumors arising in the gastrointestinal and genitourinary tracts".)

B CELL LYMPHOMA — A 45-year-old man with no significant past medical history underwent an upper endoscopy and colonoscopy for the evaluation of iron deficiency anemia and nonspecific abdominal pain. The endoscopy revealed a single 2 cm by 3 cm ulcerated lesion of malignant appearance in the stomach body (picture 3 and picture 4). The colonoscopy was normal to the terminal ileum. (See "Epidemiology, clinical manifestations, pathologic features, and diagnosis of diffuse large B cell lymphoma".)

FUNDIC GLAND POLYP — A 52-year-old woman underwent an upper endoscopy for the evaluation of persistent acid reflux and epigastric abdominal discomfort. The patient's only medical condition is gastroesophageal reflux disease for which she takes a proton pump inhibitor. Endoscopy revealed a small polyp in the gastric fundus (picture 5 and picture 6). (See "Gastric polyps".)

XANTHOMA — A 56-year-old male underwent an upper endoscopy for the evaluation of worsening heartburn and nausea. Upper endoscopy revealed two small 4 mm yellow nodules in the fundus (picture 7 and picture 8); the esophagus and duodenum were normal.

GASTROINTESTINAL STROMAL TUMOR (GIST) — A 68-year-old man underwent an upper endoscopy for the evaluation of hematemesis. Upper endoscopy revealed one actively oozing 20 mm by 30 mm submucosal mass in the stomach body; the esophagus and duodenum were normal. Bleeding was controlled after injection of 1:10,000 epinephrine and bipolar electrocautery (picture 9 and picture 10). (See "Clinical presentation, diagnosis, and prognosis of gastrointestinal stromal tumors".)

SIGNET RING CANCER — A 54-year-old man presented to his primary care physician complaining of early satiety and unintentional 10 lb weight loss over the past two months. An upper endoscopy revealed diffuse gastric wall thickening with poor distention of the gastric lumen when air was insufflated, suggestive of an infiltrative process (picture 11 and picture 12).

MALT LYMPHOMA — A 50-year-old Chinese woman with no significant past medical history presented to her primary care physician complaining of increased frequency of epigastric abdominal pain. She denies any fever, nausea, vomiting, weight loss, fatigue, diarrhea, changes in bowel habits, and has a good appetite and level of energy. She takes no medications and denies any alcohol or tobacco use. The patient is concerned because a sister, who lived in China, died at age 53 of gastric cancer. Her physical examination and laboratory data were all unrevealing. Her work-up included a colonoscopy (normal to the terminal ileum) and upper endoscopy that revealed a superficial ulceration with mucosal thickening in the incisura with surrounding erythema (picture 13 and picture 14). (See "Association between Helicobacter pylori infection and gastrointestinal malignancy" and "Clinical manifestations, pathologic features, and diagnosis of extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT)".)