Non-Organic Gastric Filling Defects Simulating Carcinoma

Abstract

The majority of benign and malignant gastric tumors are located in the pars pylorica of the stomach and reveal their presence roentgenologically as prepyloric deformities. Gastric spasm and extra-gastric lesions may produce such deformities. The differential diagnostic features of these defects have frequently been described. In a recent paper on gastric cancer, B. R. Kirklin (4) summarized the roentgenological findings usually considered as the pathognomonic syndrome of advanced mucoid carcinoma: a gross filling defect projecting from a wide base far into the gastric lumen; an irregular internal margin; sharp demarcation from the uninvolved portion; and, as a rule, little or no alteration in the size of the stomach. These features may be associated with physical signs and secondary manifestations, namely, a palpable mass; fixation of the stomach; destruction, effacement, or smoothing of the gastric rugae; absence of peristalsis from the affected portion, and rapid emptying time unless obstruction is present. Kirklin includes gastrospasm and various extrinsic conditions among lesions to be differentiated from carcinoma and states that the deformity produced by carcinoma is persistent as to site and configuration, withstands manipulation, and remains unchanged at subsequent examinations, while distortions caused by simulants have none of these qualities. We are presenting the history, the roentgenologic, operative, and pathologic findings in two patients in whom a diagnosis of gastric carcinoma was made, based on most of the diagnostic features listed above. In both instances our diagnosis was incorrect. Case 1: R. C., a male, age 51, was admitted to St. Luke's Hospital, Dec. 29, 1941. He complained of pain, varying from dull to intense, in the upper abdomen, epigastric distress following meals, occasional vomiting, and failure to get the relief alkaline powders had previously given him. His first gastric symptoms dated back one year, at which time he first experienced epigastric discomfort, bloating, and belching. Except for recurrences of similar dyspepsia within six months and again a few days prior to his admission, he had felt quite well, showing no lassitude, loss of weight, or weakness. Five days prior to admission, Dr. James T. Case had made a complete roentgenologic study of the patient's gastro-intestinal tract. A diagnosis of organic lesion of the pylorus was made, the exact nature of which was not stated. The lesion was thought, however, to be due to an inflammatory process. Physical examination was negative except for a mild dyspnea. Laboratory findings of note were as follows: hemoglobin 15.1 gm.; R.B.C. 5,090,000; gastric contents, free HCl 56°, total acid 68° two blood Kahn tests negative. Five stool examinations were negative for blood and amoebae. Total N.P.N., blood sugar, blood calcium, and cholesterol were within normal limits. The sedimentation rate was within normal limits.