Presentation
Abdominal pain.
Patient Data
Diffuse gastric wall thickening, mucosal hyperenhancement, and submucosal edema.
Possible mild mesenteric panniculitis. Tiny urachal cyst. Pancreas tail splenule (confirmed on future MRI).
Severely edematous and erythematous gastric mucosal and thickening of the gastric folds. Biopsies were taken at the time of EGD.
Resolution of gastric wall thickening which now appears normal. Mild mesenteric panniculitis.
Case Discussion
Pathology from EGD biopsy revealed hyperplastic foveolar gastric epithelium with chronic inactive gastritis and areas of ulceration, negative for H. pylori. The histological findings are consistent with Menetrier disease in the correct clinical setting. There is no further testing to increase the diagnostic confidence of this very rare disease.
The patient was started on anti-EGFR monoclonal antibody therapy based on the results of a small trial (this drug blocks the activity of elevated intragastric TGF and prevent overgrowth of the stomach lining and excessive mucous production). The patient had a positive early response to therapy which confirms the diagnosis. The patient had a radiographic response as seen on the follow-up CT many years later. While this is a benign hypertrophic gastropathy, ongoing monitoring and biopsy is required to ensure no dysplasia or neoplasia form.
The imaging findings are relatively non-specific and overlap with an infectious or inflammatory gastritis, and require further work-up with EGD and biopsy to confirm the diagnosis.