Clinical Diagnosis Reasoning
The patient presents with symptoms suggestive of upper gastrointestinal bleeding (haematemesis, pallor, hypotension) and abdominal pain. Key findings from investigations are:
- CECT: Large exophytic tumor ($13 \times 8$ cm) in the stomach fundus.
- Endoscopy: Intact overlying mucosa.
- Biopsy: CD117 positive staining.
The combination of an exophytic gastric mass, intact overlying mucosa, and crucially, positive CD117 staining, strongly points towards a specific diagnosis.
Differential Diagnosis Analysis
Stomach Tumor Types
- Gastric lymphoma: While possible, lymphomas typically involve the mucosa more diffusely and are not characterized by CD117 positivity.
- Gastrointestinal stromal tumor (GIST): GISTs arise from the interstitial cells of Cajal and are the most common mesenchymal tumors of the GI tract. They often present as exophytic masses, can cause bleeding, and are characteristically positive for CD117 (KIT protein). This aligns perfectly with the findings.
- Carcinoid tumor: These are neuroendocrine tumors. While they can occur in the stomach, CD117 is not the primary diagnostic marker, and their typical presentation and histology differ.
- Carcinoma stomach (Adenocarcinoma): This is the most common malignant tumor of the stomach, but it is typically a mucosal adenocarcinoma. Positive CD117 staining is rare in gastric adenocarcinoma.
Conclusion
The definitive finding is the positive staining for CD117. This marker is highly specific for Gastrointestinal Stromal Tumors (GISTs). The tumor's size, exophytic nature, and location are also consistent with a GIST.
Therefore, the most probable clinical diagnosis is Gastrointestinal stromal tumor.
Important Questions from Stomach
- A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = $106/min$, BP = $100/70$ mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size $13 \times 8$ cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
- The most common metabolic abnormality associated with gastric outlet obstruction is
- Which of the following statements about peptic ulcers is correct?
- A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:
- All of the following are sequelae of peptic ulcer surgery EXCEPT:
