Carcinoma of the stomach.
An elderly retired medical practitioner with a six-month history of dyspepsia. Self-medicating with omeprazole. Then developed symptoms of gastric outlet obstruction and had a small hematemesis. Endoscopy showed a chronic pre-pyloric ulcer and a narrowed, scarred duodenal cap, which could only be entered with difficulty. Biopsy of the pre-pyloric ulcer showed severe dysplasia. The patient underwent surgery, and diagnosis of an antral carcinoma was confirmed.
The endoscopy photograph shows the chronic ulcer.
The pathological specimen shows the ulcer in the distal stomach with raised, rolled edges.
The arrow points to the duodenum - the cancer lies about 1 cm from the duodenal margin. A partial gastrectomy has been performed.
Comment: distal stomach cancers are becoming less common in Western communities, whilst those at the cardia have shown a dramatic increase in incidence. The development of dyspepsia as a new symptom in an older patient should ring alarm bells - particularly if we are the patient!
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