Fibromyxoma of the Stomach Projecting into the Duodenum

Abstract

In 1921 Carman reported the roentgenologic and pathologic findings in a case of hemangioma of the duodenum. Recentlv a case has been encountered with simila'r roentgenologic findings, due to a pedunculated tumor arising on the gastric side of the pylorus and projecting into the duodenum. Case A469927. A man, aged forty-five years, came to the Mayo Clinic August 21, 1924, complaining of pain and tenderness in the precordial area, of three weeks' duration. The pain was brought on by exercise, was sharp, and accompanied by dyspnea and a choking sensation, with rapid irregular heart beats. The patient's appetite was good; he did not have indigestion, He had vomited occasionally, always without nausea. The patient was a stocky, well built man, slightly anemic in appearance. His teeth were in bad condition. He had moderate arteriosclerosis and slight cardiac hypertrophy. There was an aortic systolic murmur, and the blood pressure was 144 and 70; there was no edema. The prostate gland was moderately enlarged. Laboratory examination revealed a slight trace of albumin in the urine, secondary anemia with 3,270,000 erythrocytes, hemoglobin 47 per cent, color index of 0.7 per cent, and slight poikilocytosis, anisocytosis and polychromatophilia. Gastric analyses revealed achlorhydria, and total acidity 10. The stools were positive for occult blood. The electrocardiograph indicated a left ventricular preponderance. X-ray examination disclosed a peculiar deformity of the duodenal cap, probably due to a benign tumor, and on this basis an exploratory operation was advised, other supportive data being the secondary anemia, achlorhydria, and occult blood in the stools. At operation a normal but distended pylorus, and a pedunculated gastric tumor attached to the upper wall of the stomach and extending 7.5 cm. into the duodenum were found. After placing a clamp on the pedicle at the level of the stomach, an incision was made 2.5 cm. above the pylorus on the greater curvature of the stomach, passing upward obliquely for 3.75 cm. toward the lesser curvature, and the tumor was removed through this incision. Removal of the tumor left a raw surface 2.5 cm. long, which was sutured over with chromic catgut. The pathologist's diagnosis was: Single ulcerated fibromyxomatous polyp (8 cm. long and 2 cm, in diameter). The character of the patient's symptoms did not suggest a gastric lesion; it was only revealed by X-ray examination which was made as a matter of routine.