A 56-YEAR-OLD previously healthy woman came for treatment after an episode of hematemesis. She denied a history of weight loss, excessive alcohol ingestion, difficulty swallowing, symptoms of gastric outlet obstruction, previous hematemesis, esophagitis, gastritis, gastric or duodenal ulcer, or a diagnosis of Helicobacter pylori infection. Physical examination demonstrated a seemingly healthy middle-aged woman with mild epigastric tenderness but no other abnormal findings. She was treated in an urgent fashion with resuscitation using a crystalloid solution, insertion of a nasogastric tube, and was to receive nothing by mouth. Laboratory tests were also performed expeditiously. The patient's hemoglobin level was 7.45 mmol/L (12.0 g/dL), platelet count was 220.0 × 109/L, and international normalized ratio and partial thromboplastin time were normal. Early upper gastrointestinal tract endoscopy results revealed a fundal mass with an overlying ulcer. No active bleeding was present. Biopsy results were normal. Upper gastrointestinal x-ray films demonstrated a 4-cm circular mass outlined by contrast enhancement in the fundus of the stomach (Figure 1). A computed tomographic scan of the abdomen showed a gastric fundal mass adjacent to the diaphragm and spleen.
A. Gastric lymphoma
B. Giant type V gastric ulcer
C. Gastric stromal tumor
D. Linitis plastica
Feliciano DV. Image of the Month. Arch Surg. 2001;136(5):597. doi: