Clinical presentation

A 62-year-old woman with a history of hypertension and diabetes mellitus presented with 3 days intermittent passage of melena. Physical examination was unremarkable. The pertinent laboratory findings were haemoglobin, 10.3 g/dL (normal range, 12.0–16.0 g/dL); platelet count, 136×10³/μL (normal range, 150–400×10³/μL); prothrombin time, 11.9 s (control, 10.6 s; international normalised ratio, 0.91); and activated partial thrombin time, 28.1 s (control, 31.3 s). Esophagogastroduodenoscopy (EGD) revealed a 3 cm tumour with a central ulceration and adherent blood clot protruding into the gastric antrum (figure 1A); biopsy revealed chronic gastritis. She was treated with proton-pump inhibitors, and EGD performed 1 month later …