17798              FUNGATING CARCINOMA OF THE STOMACH

The patient was man aged 75 with a history of severe upper abdominal pain and vomiting for 6 weeks, with a loss of weight.  There was generalised abdominal tenderness and the liver was enlarged 1 finger.  The BUN was 190 mg% and the haemoglobin 16.1 g.  The serum sodium was 170 m,eq/l.  After rehydration the BUN remained slightly elevated.  Barium swallow and oesophagoscopy were unsatisfactory because of lack of co-operation, but the lower oesophagus appeared to be narrow.  He died of bronchopneumonia 3 weeks after admission.

The specimen shows a generally small stomach.  There is a large fungating carcinoma high up on the lesser curvature.  The internal surface of the tumour shows extensive ulceration and necrosis and there has been some diffuse mucosal extension around the posterior wall of the stomach.  The tumour

has also extended to surround the cardiac opening, which is considerably narrow and rigid.  Direct extension has also occurred into the lesser omentum.  Histology shows well differentiated adenocarcinoma.