This cancer presented in a 40-year-old woman complaining of abdominal pain. Endoscopically it was a "very suspicious" ulcer. Biopsy showed diffusely infiltrating signet ring cell adenocarcinoma. These are gross photos of the subtotal gastrectomy specimen. The photo above is asen face view of the ulcer. The pyloric margin is to the left. The ulcer is on the lesser curvature.
This is a longitudinal section cut in the plane of the lesser curvature. The pylorus is to the left. Note several prominent nodes of the lesser omentum; these contained metastatic cancer.
A more subtle featue of the cancer can be seen by comparing the gastric wall on the left and right sides of the ulcer. To the left, the normal anatomic layers (mucosa, submucosa, muscularis propria, and serosa) are clearly identifiable, and no tumor is grossly present. The wall to the right of the ulcer also shows identifiable anatomic layers, but they are all cemented together by the white carcinoma that extends between the layers, like icing in a layer cake.
Photograph by Ed Uthman, MD. Public domain. Posted 3 Jan 99
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