Correct answer: e.
Discussion
The ulcers are too thickened and indurated for CMV gastritis or benign ulceration. Linitis plastica rarely causes ulceration. A gastric lymphoma may appear similar and would be the main differential diagnosis. However, the gastric wall is studded with discrete nodules whilst the intervening mucosa appears normal. There are numerous distinct deposits with a normal intervening mucosa, making metastasis the most likely diagnosis. In this patient taking tamoxifen, metastatic breast cancer would be the first diagnosis.
Infiltrating lobular carcinoma of the breast is particularly associated with peritoneal disease. In a retrospective analysis by McLemore et al., the mean interval between primary diagnosis and metastatic presentation was 7 years.1 In view of the long interval, it is particularly important to highlight the endoscopic diagnosis of gastric metastasis to your histopathology colleagues; this should prompt them to obtain the original histology slides of the primary breast cancer to compare the microscopic appearance with that of the endoscopic biopsy samples. Gastric metastasis from breast cancer is, of course, terrible news; the mean survival was reported as 28 months in the study by McLemore and colleagues.
Please log in with your myUEG account to post comments.