Metastases to the stomach wall presenting as simple polyps

Abstract

Throughout the gastro-intestinal tract, the benign polyp when outlined with barium has typical characteristics. This case report offers a word of caution. A 61-year-old garage manager gave a six-week history of dyspnoea, purulent sputum, haemoptysis, anorexia and weight loss. He had smoked 20 cigarettes daily for many years. Examination revealed a pale, emaciated man with finger clubbing and a fever (101°F). The chest was emphysematous and the liver palpable. Investigations showed a severe iron deficiency anaemia (Hb 6·9 g per cent) and an elevated ESR (56 mm/hour). Repeated examinations of the sputum were negative for both acid-fast bacilli and neoplastic cells, however culture grew staphylococcus aureus. The serum albumen was 2·9 g per cent and alkaline phosphatase 15 kA units; a later liver biopsy was normal. The chest radiograph revealed a large cavity in the right upper lobe of generally emphysematous lungs. Lymph node masses were present at the left hilum and there was pneumonic consolidation in the left lower lobe (Fig. 1). Bronchoscopy showed mucopurulent secretions in the right upper lobe segmental orifice but no tumour was visible. An aspiration biopsy of the upper lobe cavity done under fluoroscopy did not yield any malignant cells. A barium meal done because of the gross anaemia showed a smooth, oval, 1·6 cm long filling defect, with a smaller adjacent defect, in the middle of the body of the stomach near the greater curvature.