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Gut. 2007 December; 56(12): 1684.
PMCID: PMC2095688

Haematemesis with mediastinal lymphadenopathy

Clinical presentation

A 33‐year‐old previously well man presented with sudden haematemesis and mild epigastric tenderness. At endoscopy, bleeding from a “ragged” lesion at the gastro‐oesophageal junction was noted and biopsy samples were taken. Follow‐up gastroscopy showed a 3 cm submucosal mass (fig 11).). A computed tomography (CT) scan confirmed the presence of a soft tissue mass arising from the gastro‐oesophageal junction extending into the gastric lumen and also showed hilar and mediastinal lymphadenopathy and bilateral, predominantly mid‐zone, nodular shadowing (fig 22).).

figure gt108472.f1
Figure 1 Endoscopic appearance of gastro‐oesophageal mass.
figure gt108472.f2
Figure 2 CT appearance of gastro‐oesophageal mass.

The patient later developed epigastric discomfort, nausea, exertional dyspnoea and cervical lymphadenopathy. Figure 33 shows the histopathology of the specimen taken from the gastro‐oesophageal junction.

figure gt108472.f3
Figure 3 Microscopic appearance of biopsy samples from the gastro‐oesophageal junction.

Questions

What was the cause of this patient's gastrointestinal bleed?

What is the diagnosis?

See page 1695 for answers


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