Volume 84 - 2021 - Fasc.4 - Letters
Gastric adenocarcinoma with enteroblastic differentiation: an unexpected cause of upper gastrointestinal bleeding
A 78-year-old male with previous medical history of
hypertension, dyslipidemia, benign prostatic hyperplasia
and colectomy for colon adenocarcinoma 16 years
earlier presented to emergency department with melena
for approximately 2 weeks. He denied hematemesis
or hematochezia. He also denied other symptoms
including abdominal pain, nausea, vomiting, fever,
anorexia or weight loss. Usual medications included
silodosin, simvastatin, losartan, hydrochlorothiazide,
pantoprazole and midazolam. He denied recent intake
of iron supplements or non-steroidal anti-inflammatory
drugs. Physical examination was unremarkable except
for pale skin. Laboratory studies revealed the presence
of anemia (hemoglobin level: 7.1 g/dL). Leukocyte and
platelet counts, liver tests, renal function, electrolyte
levels, C-reactive protein and coagulation studies were
all normal. Upper digestive endoscopy revealed red
blood and blood clots in gastric lumen and a polypoid
lesion with a diameter of approximately 20 mm located
at the greater curvature of the proximal body with active
oozing hemorrhage (Figure 1). Bleeding was successfully
controlled with injection of diluted epinephrine at the base
of the polyp and the patient was admitted in intermediate
care unit for close monitoring.
During the following days,
