Presentation
Progressive weight loss, abdominal pain, nausea and repeated vomiting.
Patient Data
An intraabdominal sizable soft tissue mass with necrotic components is seen intimately related to the pylorus. It shows tracking of contrast inside with variable hypodense areas of breaking down and cavitary formation. The gastroduodenal artery is seen traversing the mass. It measures 11.4 x 9.5x 9.6 cm in it's anterior-posterior, width and height respectively.
The mass has the following relations:
Superiorly it lies beneath the right lobe of the liver and near the gallbladder and portahepatis.
Anteriorly it causes focal bulge of the anterior abdominal wall.
Posteriorly it displaces the IVC, SMV and portal veins.
Inferiorly: It causes large bowel (transverse colon) displacement.
Laterally it displaces the surrounding bowel and pancreas. Retro-aortic appearance of the left renal vein.
Gastroscopy showed severe mural wall thickening and narrowing of the pylorus.
Intraoperative images with gross macroscopic pathology for gastric lymphoma.
Large B-cell non-hodgkin gastric lymphoma, rich in histiocytes is proved after histopathology with an immunohistochemical confirmation.
Case Discussion
The patient had a CT that revealed large degenerated soft tissue mass intimately related to the pylorus. The possibility of GIST vs other differentials was considered. Gastroscopy was then performed and revealed severe mural wall thickening and narrowing of the pylorus. The patient underwent surgery, confirming a large mass than estimated by radiologic and laparoscopic procedures.
Gastric lymphoma: large B-cell non-hodgkin type, rich in histiocytes is proved after histopathology with an immunohistochemical confirmation.
The case is courtesy of Dr. Hani Fahmy, G.Surgery Consultant,
Thanks to Dr. Mamdouh Radwan for Path. Photo.
Thanks to Dr. Hani Afifi, Gastroenterologist for Laparoscopic photo.