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ItsTime A 31 y/o male with a history of recurrent epigastric pain, nausea, and occasional vomiting since 6 months, weight loss. Epigastric pain was intermittent, mild, and gnawing in character. A chest X-ray, complete blood count, and liver and renal function tests were normal. ESR was 22 mm/hr. Physical examination only revealed direct tenderness in the epigastrium. There was no lymphadenopathy. His HIV status was negative. CT of abdomen suggested thick antrum with dilated stomach, without any lymph node enlargement or ascites. Upper GI endoscopy showed an irregular mass lesion at the antrum and pylorus region with narrowing of the lumen. What diagnosis can you make? Suspected TB case.

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Thickened antrum Mass lesion seen Take biopsy to r/o CA stomach H/o wt loss intermittent epigastric pain not a/w fever loss of appetite unlikely tubercular

Thanx dr Ashok Leel
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On endoscopy an irregular mass lesion at the Antrum and pylorus region with narrowing of lumen - always think of malignancy first - Ca stomach Although in D/D - tuberculosis can be there . Take an endoscopic biopsy to confirm the Diagnosis.and to differentiate benign from a malignant growth as treatment depends upon the biopsy report

CT shows,Bowel wall thickening, stomach is dilated and possibly hemorrhagic collection with in. Hypoechoic vertebral lesion seen. Endoscopic view shows yellowish mucosal tubercles, and errythema and a clot . Findings favours TB. Needs lesion biopsy HPE to conclude. Medical management accordingly.

Endoscopic findings an erregular mass at the pyloric region and antrum causing narrowing of lumen the first cause comes in mind as malignancy but considering the age may be due to tuberculosis Endoscopic biopsy and HPE will guide us to the proper diagnosis.

*Acid peptic disease ** Malignancy Needs further investigation and evaluation to conclude and line of treatment.

Thanks Dr kute Ankush
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Acid peptic disease with stricture and gastric outlet obstruction.malignancy will be a differential diagnosis.

IT'S A..CASE OF.. ? GASTRIC PATHOLOGY.. MALIGNANCY.. ? APD .. NEED'S.. FURTHER EVALUATION WITH.. HPE STUDY..

Tnx Dr Shivraj Agarwal sir
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Malignancy D/D Tuberculosis Ad biopsy to confirm the diagnosis

SUGGESTIVE OF TUBERCULAR DD A. P. D

Here are possibilities Gastric ulcer with chronic inflammation ? Tuberculous etiology ? APD ? Malignancy Adv : biopsy

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