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JAMA Surgery Clinical Challenge
December 2015

A Case of Unexpected Gastric Mass

Author Affiliations
  • 1Dipartimento di Chirurgia, Chirurgia Generale e Epatobiliare, Policlinico G. B. Rossi, University of Verona, Verona, Italy
JAMA Surg. 2015;150(12):1187-1188. doi:10.1001/jamasurg.2015.0981

A woman in her 70s was referred to our tertiary care center for an asymptomatic mass of the gastric fundus. Her medical history was significant for chronic gastritis, which was being treated with esomeprazole 20 mg; a laparoscopic cholecystectomy 18 years prior; and excision of a 26-mm Merkel cell carcinoma of the left knee with negative results of the sentinel lymph node biopsy (stage II) 19 months prior. Results of the patient’s follow-up examinations were negative until a high-resolution computed tomographic scan showed a 45 × 40-mm intraluminal protruding mass with slightly enlarged lymph nodes along the lesser curvature of the gastric fundus (Figure, A). Results of fluorine 18–labeled fluorodeoxyglucose and gallium citrate Ga 68–labeled 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic (DOTA)-D-Phe1-Try3-octreotide (DOTATOC) positron emission tomography confirmed the presence of a metabolically active mass in the gastric fundus (maximum standardized uptake value, 6) with intense 68Ga–DOTATOC uptake (maximum standardized uptake value, 24) as well as mild 68Ga–DOTATOC uptake in 2 lymph nodes of the lesser curvature.

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