OMED E-Newsletter Issue 6, 2009: Brainteaser/image of the month
This was found in a 38 year old female undergoing gastroscopy for abdominal discomfort.
What is the most likely diagnosis?
- gastric adenoma
- early gastric carcinoma
- submucosal mass or tumour
- H.P associated gastritis
- gastric lymphoma
Explanation
Option E is correct. This turned out to be a gastric lymphoma (a low-grade MALToma). Thickened, infiltrated and erythematous mucosa appearing mucosa is usually due to HP associated gastritis. However, in this case there is a circumscribed thickening of the gastric folds but without ulceration. If the abnormal mucosa is ulcerated, the main differential diagnosis of ulcerated and infiltrated gastric mucosa includes gastric lymphoma, CMV gastritis and gastric amyloid. In contrast, a linitus plastica does not usually appear to be ulcerated.