A 59-year-old man is evaluated in the clinic for recent unintentional weight loss. He says, "My pants are fitting a lot looser than usual." The patient also has epigastric discomfort after meals with occasional nausea. He reports that food is not as appetizing as it used to be. He has no known medical conditions and takes no medications. The patient's father has a history of peptic ulcer disease. Upper endoscopy shows a lesion in the stomach that is biopsied; a histologic section is shown below: This patient's lesion is most likely to demonstrate which of the following gross findings?

Question

A 59-year-old man is evaluated in the clinic for recent unintentional weight loss.  He says, "My pants are fitting a lot looser than usual."  The patient also has epigastric discomfort after meals with occasional nausea.  He reports that food is not as appetizing as it used to be.  He has no known medical conditions and takes no medications.  The patient's father has a history of peptic ulcer disease.  Upper endoscopy shows a lesion in the stomach that is biopsied; a histologic section is shown below:  This patient's lesion is most likely to demonstrate which of the following gross findings?

Quizplus · Accepted Answer

11ec160b_3948_8cb1_9249_17d610e151b2_MD0001_00 This image shows typical features of diffuse-type adenocarcinoma, 1 of 2 major types of gastric adenocarcinoma. Diffuse-type adenocarcinomas often consist of signet ring cells that do not form glands. Signet ring cells contain abundant mucin droplets that push the nucleus to one side and lead to the characteristic appearance of a signet ring. On gross examination, diffuse-type adenocarcinomas are characterized by diffuse involvement of the stomach wall (due to loss of the cell adhesion protein E-cadherin). They have a plaque-like appearance, are ill defined, and often infiltrate large areas of the stomach wall, causing a "leather-bottle" stomach (linitis plastica). In contrast, intestinal-type adenocarcinomas of the stomach resemble colon cancers, showing well-formed glands that consist of columnar or cuboidal cells. They tend to grow as nodular, polypoid, and well-demarcated masses that rapidly expand within the gastric lumen (Choice D). These lesions often ulcerate/bleed and must be differentiated from peptic gastric ulcers by biopsy (Choice A). (Choice C) Chronic gastritis is most commonly associated with Helicobacter pylori infection. Long-standing inflammation of the gastric mucosa can lead to diffuse gland atrophy and intestinal metaplasia. Chronic gastric inflammation increases the risk of gastric carcinomas. (Choice E) Rugal thickening with acid hypersecretion is a characteristic finding in the stomach of a patient with Zollinger-Ellison syndrome. Educational objective: There are 2 morphological variants of gastric adenocarcinoma. The intestinal type forms a solid mass that projects into the stomach lumen and is composed of gland-forming cuboidal or columnar cells. In contrast, diffuse-type adenocarcinoma infiltrates the stomach wall (linitis plastica) and displays signet ring cells on light microscopy. __________ References: Gastric cancer: classification, histology and application of molecular pathology. (http://www.ncbi.nlm.nih.gov/pubmed/22943016)

A 59-Year-Old Man Is Evaluated in the Clinic for Recent