A 67-year-old man with cognitive decline incidentally diagnosed with gastric submucosal tumor

Abstract

Introduction.–Vitamin B12 deficiency can lead tomemory loss, disorientation and dementia is well known from the past. Therefore when we first meet the patient who have cognitive decline, we must check the Vitamin B12 level. Methods and results.– A 67-year-old man visited our clinic with cognitive decline. He had no specific past history of illness. Two years ago, memory complaint was started. His neuropsychological test showed both frontal and left temporal lobe dysfunction. His educationwas 16years. Korean-MiniMental State Examination (KMMSE) score was 26 and Clinical Dementia Rating (CDR) score was 0.5. And sum of box score was 4. He was in mild dementia state. The routine lab tests revealed that he had vitamin B12 deficiency. Vitamin B12 level was 45pg/mL and homocysteinwas 83.8umol/L. His hemogoblin was 13.3 g/dL. Antiparietal cell antibody(Ab) was positive and anti intrinsic factor Abwas negative. Gastrin level was increased. Under the esophagogastroduodenoscopy, there was no evidence of atrophic gastritis but gastric submucosal tumor was found. If the autoimmune gastritis was in chronic state, atrophic gastritismight be found. Usually after chronic stage of autoimmune gastritis, gastric cell dysplasia and submucosal tumor can occur. But in this case, there was no anemia and no atrophic gastritis. It suggests his hypovitaminosis B12 state has not been that long. Conclusions.– Whether his submucosal tumor was due to autoimmune gastritis or incidental growth, it was a unique case who did not have pernicious anemia and atrophic gastritis have a gastric submucosal tumor.