Three lesions

Three gastric lesions (A,B and C) in three separate patients all undergoing a gastroscopy because of iron deficiency anaemia
WHAT IS YOUR ENDOSCOPIC DIAGNOSIS?

■ BENIGN GU's

INCORRECT!

■ GASTRIC ADENOMAS

INCORRECT

■ EGC's

CORRECT!

EXPLANATION

These are all intramucosal gastric cancers. The typical scenario of an early gastric cancer is: 

1. The patient is undergoing the examination because of iron deficiency anaemia (the reason is that these pts are achlorhydric and malabsorb iron)
2. The gastric mucosa appears patchily inflamed with red and paler areas 
3. After a more careful search, you find a distinct red patch which on closer scrutiny (washing and blue dye or if you have it NBI and magnification) is found to be surrounded by a slightly raised edge (which can be seen in all 3 examples here).
   
   As the blue dye slides off the central cancers which are very smooth, you end up with a red spot surrounded by an elevated ridge. Presto - The diagnosis is made !