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Case 85

Gastric lymphoma

Barium meal of a 22 year old with epigastric pain

This 22 year old woman was referred by her General Practitioner for a barium meal for epigastric discomfort. She had also lost a stone in weight recently. There was no other history of note. On examination there was a fullness of the upper abdomen.

Findings

There is a large mass indenting the lesser curve of the stomach, with a rolled edge and a large central ulcer crater. The ulcer crater is within the projected line of the lesser curve. The normal gastric mucosal folds are absent over the mass itself. These features are those of a malignant gastric ulcer.

Diagnosis

Primary gastric lymphoma (Burkitt type high grade lymphoma).

Discussion

In an elderly patient this would be a reasonable appearance for a gastric carcinoma, a relatively common malignancy. However this patient was only 22, making gastric carcinoma much less likely. In this group alternatives need to be considered, and lymphoma is one of the commoner malignancies at this age.

Lymphoma may involve the GI tract late on in the course of the disease, but, as here, it may also arise primarily within bowel. Further investigation (including CT) revealed no evidence of spread elsewhere. Such cases may have a relatively good prognosis.

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