Pathology Cases: GI1 Case A 10 year Follow Up Answers

Mr. Harper comes to your office after 10 years. The last time you saw him, you prescribed him triple therapy antibiotics for his H. pylori infection and counseled him on the his use of NSAIDS and its role in exacerbating his disease process. He now returns to you again on the urge of his doting wife. While she initially believed Mr. Harper was on a new routine because of his noticeable weight loss, she now fears he looks emaciated and does not understand why. On questioning him, you find out the Mr. Harper finished his course of antibiotics, but did not take it on the schedule you prescribed; eventually taking them on a prolonged self-directed course. He now has regular epigastric pain. You confirm with Mr. Harper that he has continued his lifestyle of alcohol abstinence.

On physical exam, you are struck by these abnormal findings. Name each in clinical terms.

Ancanthosis Nigracans

Virchow's Node

Sister Mary Joseph Sign

Sign of Leser-Trelat

What is your top diagnosis?

Possible Intestinal Type Gastric Adenocarcinoma. Most Common gastric carcinoma.

What are 6 risk factors for your top diagnosis? (Goljan)

1. Intestinal metaplasia due to H. pylori (most important)

2. Nitrosamines

3. Smoked Foods (Japan)

4. Diets lacking fruits and vegetables (med school diet?)

5. Type A Chronic Atrophic Gastritis

6. Menetriere's Disease

What are the most common locations of this disease in the stomach?

Lesser curvature of pylorus and antrum (50-60%)

Which of the two following images matches your diagnosis? Discuss why the other photo does not match your diagnosis/clinical picture. (See Answers for pathologic slides of your diagnosed disease process)

Photo B correlates to your diagnosis of Intestinal type of Gastric Adenocarcinoma.
Photo A is describes a Diffuse type of gastric adenocarcinoma by it's histologically unique "SIGNET RING" cells. This cancer is NOT associated with H. Pylori. It is sometimes called Linitis Plastica. It also has the potential to produce Krukenberg tumors of the ovaries.