Giant Benign Gastric Ulcers

Abstract

Recently we have collected a group of 7 cases of large, gastric ulcers with clinical features and surgical findings that suggested malignancy, but which after resection, were all proven to be benign. The term, giant benign ulcer of the stomach, has been used because the large size of the ulcer, each more than 3.5 em. in diameter, was the most striking feature of the disease process. The average age of onset was 60.0 years, the youngest patient was 50 and the oldest 74. Clinically, the chief complaint was abdominal pain, not responding to a strict ulcer regime. Progress of the patient as followed by X-ray failed to reveal any evidence of healing of the gastric lesion. Because of these factors the clinical impression was malignancy. On roentgen examination, all these giant ulcers were visualized on the posterior wall near the lesser curvature in the mid-corpus of the stomach. Gastroscopically, the ulcers presented smooth, regular, well-defined margins, but the bases were necrotic. At laparotomy, a hard, indurated mass involving the stomach, pancreas and occasionally the liver or mesentery, was found. The surgeon, in some instances, was reluctant to resect the stomach because the huge, indurated mass suggested an extension of the malignancy into adjacent tissues. The characteristic pathology was a complete, walled-off perforation through the entire thickness of the gastric wall. The base of the ulcer was formed by the capsule of the pancreas or liver. Microscopic examination of the lesion, however, revealed chronic, benign, gastric ulcer. Since subtotal gastrectomy is curative, the possibility that a giant, gastric ulcer is benign must be considered.