Residency Program - Case of the Month

Clinical history:

A 63-year-old female with a past medical history of gastrointestinal bleeding from a gastric ulcer and H. pylori infection presented with new complaints of melena, progressive weakness, fatigue and shortness of breath. Labs were consistent with iron deficiency anemia and a hemoglobin of 3.2 g/dL.  An upper endoscopy revealed a large, ulcerated gastric mass between the incisura and antrum, concerning for malignancy (Figure 1). Abdominal CT scan demonstrated a 9.0 x 6.0 x 5.5 cm multilobulated enhancing mass involving the body and antrum, extending beyond the borders of the stomach (Figure 2).

Images:

Figure 1		Figure 2

Endoscopic biopsy: 

An endoscopic biopsy of the gastric mass was performed and included fragments of benign gastric mucosa with ulceration, as well as a small fragment of a poorly differentiated epithelioid neoplasm (Figure 3).

Figure 3

Immunohistochemical stains: 

Figure 4		Figure 5

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