Images in Clinical Medicine
Gastric Tumor Discovered by Chest Radiography
N Engl J Med 1999; 340:927March 25, 1999
- Article
Figure 1 An 88-year-old Japanese woman had a six-week history of black stools and fatigue. Her hemoglobin level was 6.7 g per deciliter, and a fecal occult-blood test (Hemoccult) was positive on two occasions. A chest x-ray film showed a round, soft-tissue mass (arrow in Panel A) within the gastric air bubble and no clinically significant intrathoracic abnormalities. An upper gastrointestinal series revealed a round, lobulated mass arising from the right lateral and posterior walls of the gastric fundus. A computed tomographic scan with oral and intravenous contrast medium revealed an intraluminal mass (arrow in Panel B) with a lower density than that of the adjacent wall and no evidence of extragastric extension. At endoscopy, an ulcerated tumor was found. The patient initially declined surgery because of her age. Two months later, however, after two episodes of acute gastrointestinal bleeding, a localized gastric resection was performed. Histologic analysis (Panel C) revealed an ulcerated, submucosal spindle-cell tumor that was negative for smooth-muscle or neural markers and positive for the filament marker vimentin (hematoxylin and eosin, ×40). Because of an inability to demonstrate differentiation or the derivation of spindle cells, the mass was diagnosed as a gastrointestinal stromal tumor. Since surgery, the patient has had no further bleeding, and her hemoglobin level has increased to 12.7 g per deciliter.
Arthur H. Zalev, M.D.
Peter A. Kopplin, M.D.
St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
