Presentation
Left upper quadrant pain and weight loss. Bloods showed hypercalcemia.
Patient Data
Large infiltrative lesion arising from the greater curvature of the stomach with invasion of the spleen. The mass encases the splenic vessels. There is discontinuity of the stomach mucosa. More focal regions of hypodensity in the spleen favored to represent necrosis. Multiple surrounding lymph nodes are present with peritoneal nodules. There is small volume ascites.
Case Discussion
Gastric lymphoma was confirmed on biopsy, which is always the differential for a homogenous lesion with aggressive features. Gastric MALToma is associated with H. pylori infection, however this case proved to be diffuse large B-cell type.
The differential is infiltrating type of adenocarcinoma, which is commonly seen in younger patients who lack E-cadherin and hence are also at risk of lobular breast carcinoma.