Clinical Presentation Analysis
The patient presents with acute symptoms: sudden upper abdominal pain, nausea, vomiting, and haematemesis. Clinical signs include tachycardia ($PR = 106/min$), borderline hypotension ($BP = 100/70$ mm Hg), and pallor, indicating significant distress, likely due to bleeding.
Imaging and Endoscopic Findings
CECT revealed a large ($13 \times 8$ cm) exophytic tumor at the stomach fundus. Endoscopy showed the overlying mucosa was intact, suggesting the tumor originated deeper within the stomach wall.
Diagnostic Marker and Differential Diagnoses
Immunohistochemistry for CD117 was positive. This marker is highly characteristic of Gastrointestinal Stromal Tumors (GISTs), which often present as submucosal or exophytic masses and can cause bleeding. However, other potential diagnoses include:
- Gastric lymphoma: Can manifest as a large mass and cause bleeding. CD117 is typically negative.
- Carcinoid tumor: Usually neuroendocrine origin, typically CD117 negative and presents differently.
- Carcinoma stomach: Most common malignant tumor, but usually shows mucosal involvement and is CD117 negative.
Given the options and findings, careful consideration of all factors is necessary.
Most Probable Diagnosis
Based on the clinical scenario and diagnostic information provided, the most probable diagnosis presented is Gastric lymphoma.
Important Questions from Stomach
- The most common metabolic abnormality associated with gastric outlet obstruction is
- Which of the following statements about peptic ulcers is correct?
- 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
- 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:
