Benign Tumor of the Stomach

Abstract

The final decision as to the malignancy or non-malignancy of a tumor must rest with the pathologist and is made from the histological examination of the suspected tumor. This necessitates the removal of the tumor. There are times when it is neither expedient nor advisable to remove the tumor. There are other times when from the history, examination, and X-ray studies doubt arises as to the class under which the tumor classifies, and “watchful waiting” seems to be the proper course. Benign tumors of the stomach are uncommon. In all the literature, not over one thousand cases have been recorded. These cases include all types of non-malignant tumors, such as papillomata, myomata, angiomata, polypi, adenomata, lipomata, cysts, fibromata, myxomata, and lymphadenomata. Carman found two cases in fifty thousand stomach X-ray examinations. The case to be described is the first seen by the writer in over six thousand X-ray examinations of the stomach. Most of the cases described have been confirmed post-operatively or at autopsy. A diagnosis of benign tumor of the stomach pre-operatively can be only presumptive at best, and yet there are certain roentgenologic characteristics of some types that have been described. With the larger visible tumors, there are certain constant features which tend to distinguish the benign from the malignant. Eliason and Wright in a study of fifty cases state: “The single tumors which are large enough to be describable stand out as globular, smooth, regular, clear, and persistent shadows, alike on the lesser and greater curvature, and by their very smooth uniform outline immediately strike one as not characteristic of the irregularity of malignancy or the scooped- or punched-out area of ulceration.” Inasmuch as the case to be described here seems to fit in with this description, and because of other features to be mentioned later, it is considered to be a case of benign tumor of the stomach. And, because of this, operation was held in abeyance. Subsequent events, since the first examination, have tended to substantiate this opinion. The patient, Mrs. K. J., housewife, age 42, was first seen on April 8, 1928. Her chief complaint was epigastric pressure. There was no regularity as to the occurrence of the attacks. One year previously she had had one series of attacks which had lasted about one month. The present series of attacks had begun four weeks before her visit to me. These attacks would come on as often as two or three times daily. Occasionally she would have a day free from attack. They came on about two hours after meals and lasted only a short time. Twice she had been awakened after midnight with bad attacks. Alkalis and walking seemed to offer the greatest relief. The attacks were associated with bloating and at times there was slight pain in the epigastrium, radiating straight through to the back. There was also a heaviness, with pressure, increased by lying on the right side.