Gastroenterology TAPE 6A, Report 5 HISTORY AND PHYSICAL EXAMINATION CHIEF COMPLAINT: The patient, a 50-year-old black woman,

presented with a 4-6 weeks history of episodes of postprandial epigastric distress. She had been taking large doses of salicylates for the relief of arthritic symptoms. She experienced upper abdominal bloating and distention after eating even small amounts of food. The complaints bore no relationships to the type of food she ate (there was no fatty or fried food intolerance) and would occur shortly after eating. There was no dysphagia, nausea, vomiting, hematemesis, or visible melena. X-rays revealed a normal cholecystogram. The x-rays of the upper gastrointestinal tract revealed a rounded radiolucent filling defect on the greater curvature of the prepyloric antral portion of the stomach. She was admitted to the hospital for further study. PHYSICAL EXAMINATION: The physical examination was generally unremarkable except for an obese, protuberant abdomen. There were no abdominal masses, tenderness, or organomegaly. LABORATORY STUDIES: Revealed a normal hemogram and urinalysis, normal electrolytes, normal SMA-12 chemical profile. Stool showed traces of occult blood. Histalogstimulated gastric analysis revealed fasting free HCl 40 mEq/L; 15 minutes, 75 mEq/L; 30 minutes, 70 mEq/L; 45 minutes, 55 mEq/L; 60 minutes, 53 mEq/L. Gastric cytology revealed no tumor cells. Gastroscopy was performed and supported the clinical impression, which was that of a hard mass on the greater curvature aspect of the stomach. It was decided to operate. PREOPERATIVE DISCUSSION: Benign tumors of the stomach are uncommon. They represent 10%-15% neoplasms of the stomach. Men and women appear to be equally affected, with peak incidence between 50 and 60 years of age. Pathologically, the following types of tumors are observed: Solitary and multiple polyps, adenomas, multiple polyposis, leiomyoma, neuroma. A displaced island of heterotopic pancreas also may present as a tumor. Pancreatic rests are most commonly

located along the greater curvature of the antrum. A definite diagnosis cannot be made by x-ray examination alone because these small filling defects may resemble those produced by other benign tumors or even by an early carcinoma. The clinical behavior of benign gastric neoplasms depends on their size, location, their tendency to ulcerate, bleed, obstruct, or undergo change. Vague epigastric discomfort may occur in some patients, whereas others may experience ulcer-like symptoms or the syndrome of pyloric obstruction if the growth is near the pylorus. In this case, pressure spot films of the suspicious area noted on fluoroscopy clearly demonstrated the tumor. CONCLUSION: It was decided to operate and remove the tumor.

FOOTNOTE: Lines 7, 24, 29, 40, 12. The dictated semicolon is changed to a colon to correct the punctuation instruction. Line 19. The word and dictated between upper and gastrointestinal is deleted. Line 24. PE was translated as physical examination in the text. Line 22. The dictated comma after stomach was changed to a period. Line 33. Alternative: ulcerlike.