22723              CARCINOMA OF THE STOMACH

The patient was a man aged 74 who was disorientated and uncooperative and a poor historian.  There had apparently been intermittent epigastric pain for 2 weeks, passing through to the back.  He was pale, the BP was 130/75 and the liver was enlarged 2 cms below the right costal margin.  Rectal examination showed dark black faeces.  The haemoglobin was 7.1 g, there was macrocytosis and the ESR was 48 mm.  On the 3rd day he vomited a large amount of undigested food, lapsed into coma and died the next day.  At postmortem there was a carcinoma of the stomach and many metastases in the liver.

The specimen consists of the stomach, which is dilated.  There is a large fleshy fungating tumour completely encircling the pylorus and narrowing the pyloric lumen to the diameter of 1 cm.  The tumour extends into the pyloric antrum for a distance of 5 cms and has involved the full thickness of the stomach wall on the lesser curvature.  Direct extension has occurred into the lesser omentum and lymph nodes in this region are also involved by tumour.  Histology shows a small celled anaplastic carcinoma.  Anaplasia is not so marked in the liver metastases.