Gastric Mass: Intramural Hematoma

Abstract

Gastric masses can be challenging to diagnose pre-operatively due to their heterogeneity in presentation and work-up. One must be cautious that a seemingly benign mass may be malignant and vice versa. Some of the more common gastric masses include peptic ulcer, adenocarcinoma, and gastrointestinal stromal tumour. These diagnoses have vastly different management strategies despite similar presentations. The case presented here is an example of this management, highlighting a patient with a gastric bleeding mass initially thought to be a gastrointestinal stromal tumour. However, on final pathology, the mass was determined to be benign, an ulcerated hematoma.

Keywords: gastric bleed; gastric tumor; gastric ulcer; mass; partial gastrectomy.

Figure 1. Endoscopic appearance of the approximately 5cm ulcerated submucosal mass located along the proximal posterior fundus.

A) Overall view of the mass. B) Close-up view of mass.

Figure 2. CT imaging of the gastric mass.

A) Axial cut of the superior abdomen, demonstrating ulceration of the mass and proximity along the superior posterior gastric wall. B) Axial cut of the superior abdomen, demonstrating proximity of the mass to the splenic hilum. C) Coronal cut of the abdomen, demonstrating proximity of mass to pancreatic tail. D) Coronal section of the abdomen demonstrating proximity to the splenic hilum.

Figure 3. Intra-operative appearance of the gastric mass.

A) Adhesions between the posterior gastric mass and spleen. B) Adhesions between mass and pancreatic tail.

Figure 4. Pathology slide demonstrating recent haemorrhage at 100x magnification with hematoxylin and eosin stain, suggestive of hematoma—courtesy of Dr Sebouh Setrakian MD.