Clinical presentation

A 44 year old woman presented with a longstanding history of epigastric pain, weight loss, and dysphagia. Upper gastrointestinal duodenoscopy demonstrated an 8 cm infiltrating tumour of the proximal (40 cm) stomach, and biopsy of the lesion demonstrated a necrotic solid tumour with a predominant epithelioid morphology arranged in small solid clusters with multiple scattered mitotic figures. Immunohistochemical staining revealed strong expression of vimentin, CD34, and c-kit in virtually all tumour cells. In view of her symptoms and histological findings, a contrast enhanced computed tomography (CT) scan of her abdomen was performed (fig 1).

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Figure 1

 Contrast enhanced computed tomography scan of the abdomen (left) and immunohistochemical staining of the biopsy specimen of the lesion (right).

Question

What do the investigations reveal as the likely diagnosis, and what are the treatment options for this patient?

See page 1616 for answer

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