Gastroscopy for pt with IDA ...

This was found on the anterior gastric wall in an elderly patient with iron deficiency anaemia
WHAT IS THE MOST LIKELY DIAGNOSIS?

■ Gastric ulcer scar

Quite possible but you would take samples surely?

■ Gastric erosion

But there is a nodule in the centre?

■ Benign gastric ulcer

But there is no 'ulcer' in the centre?!

■ Early gastric cancer

Surely, the most likely diagnosis?

explanation

Gastric folds are being pulled into this 'lesion'. Of course most EGC's are depressed or flat elevated with a central depression. This is not easy to classify into the Paris classification system. I guess that you can argue that its' an elevated lesion with a central depression? Anyway, at the centre of the lesion there is a nodule!  Not an ulcer!  It's most likely an EGC. In fact, the lesion was resected endoscopically and proved to be poorly differentiated invasive cancer with a positive deep margin ! As the patient was 84 yrs old, no surgery was offered. That was 6 years ago and the patient remains well with only an unremarkable scar in the stomach to remind him !  Wonderful !