Teaching Case

A 60-year-old male presented to the emergency room with a postprandial abdominal pain, vomiting, anorexia and weight loss. An epigastric mass could be felt on examination, and the laboratory test values confirmed that he had anaemia.

A 60-year-old male presented to the emergency room with a postprandial abdominal pain, vomiting, anorexia and weight loss. An epigastric mass could be felt on examination, and the laboratory test values confirmed that he had anaemia. The patient went through an upper gastrointestinal series that showed a polypoid irregular lobulated mass arising from the lesser curvature, with a granular surface pattern.

The radiological diagnosis of polypoid cancer starts with the determination of the size, form and the surface pattern of the tumour. With some exceptions, most lesions have a maximum diameter in the range 1–4 cm. The surface pattern of the lesion is of great importance for obtaining the differential diagnosis of malignancy and benignity. Some lesions smaller than 1cm in size have a granular surface pattern which is characteristic of early stages of cancer, and they also have a lobulated contour. The granularity of the surface, though somewhat irregular and coarse, resembles the surrounding mucosa. As the cancerous infiltration extends deeper than the submucosa, the similarity of the surface pattern disappears and is replaced by a marked erosion or ulceration in most cases. However, a large polypoid cancer preserves the similarity as long as the depth of invasion is limited to the mucosa.