Patient presented with upper abdominal discomfort, significant weight loss, anorexia and early satiety.
Loading Stack -
0 images remaining
Ultrasound of the upper abdomen shows marked circumferential asymmetrical wall thickening and obscuration of the normal layers of the distal stomach. These changes extend to the proximal duodenum.
The visualized part of stomach shows some luminal narrowing.
No visible adjacent lymphadenopathy.
Specimen ﬁxed labelled with patient’s name, consists of multiple gray white soft tissue.
Specimen is composed at large of necroinﬂammatory tissue "ulcer site", with
only one fragment showing viable gastric mucosa, showing inﬁltration of
lamina propria by sheets of large atypical lymphoid- like cells, with scattered
mitotic ﬁgures. Immunohistochemical stain including CD20, CD3, Ki67 and
CK are necessary for further sub-classification and to exclude undifferentiated carcinoma.
DIAGNOSIS: Stomach, biopsy: Malignant tumour, with features of high-grade non-Hodgkin lymphoma, for immunohistochemical stains.
In this case, we advised further evaluation with contrast-enhanced CT, but the patient's treating physician opted for biopsy.
Features that can help differentiate lymphoma from gastric carcinoma is that the wall thickening is more marked in lymphoma and extension to the duodenum is typical for lymphoma. Infiltration of adjacent organs is more likely in carcinoma. However, there is an overlap in the imaging appearance of the two conditions.