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Special Feature
May 2001

Image of the Month

Author Affiliations

From the Department of Surgery, Grady Memorial Hospital, and Emory University School of Medicine, Atlanta, Ga.

 

S. ROZYCKIGRACEMD

Arch Surg. 2001;136(5):597. doi:

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.

What Is the Most Likely Diagnosis in This Patient?

A. Gastric lymphoma

B. Giant type V gastric ulcer

C. Gastric stromal tumor

D. Linitis plastica

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