HistoryA 31-year-old morbidly obese woman presented with fatigue. Complete blood count results revealed severe anemia with a hemoglobin level of 3.8 mmol/L (normal range, 7.1-9.9 mmol/L) and hematocrit level of 0.22 (normal range, 0.34-0.48). Results of an iron study performed at an outside institution revealed iron-deficiency anemia; the patient denied experiencing heavy menstrual periods. Colonoscopy results were negative, but upper endoscopy performed the same day showed multiple 10-50-mm pedunculated and sessile gastric polyps (Fig 1). No site of active or recent bleeding was identified. A biopsy was performed, and histologic analysis of the specimen revealed carcinoid tumor cells. The patient reported no abdominal pain and had no symptoms to suggest Zollinger-Ellison syndrome or multiple endocrine neoplasia type 1 (MEN-1). She was referred to a tertiary care center for further evaluation. Imaging FindingsTo evaluate the abdomen and pelvis for metastatic disease, a three-phase computed tomographic (CT) examination was performed with a 64-channel scanner (SOMATOM Sensation; Siemens Medical Solutions, Erlangen, Germany). The phases of imaging included unenhanced, arterial, and venous phases, with a 45-second delay from initiation of injection of the contrast material bolus for the arterial phase and a 65-second delay for the venous phase. For all phases, 120 kV, 240 mAs, and 0.6-mm collimation were used. Five-millimeter axial sections were reconstructed from data acquired in each phase, with additional 0.7-mm axial reconstructions for the arterial phase and 1.0-mm axial reconstructions for the venous phase. Before the examination, the patient received 20 ounces of an oral contrast agent (MD-Gastroview; Mallinckrodt, St Louis, Mo) and 1 cup of water, as well as 150 mL of an intravenous contrast agent (Optiray 350; Mallinckrodt) administered at a rate of 4 mL per second.Axial and coronal reformatted images were reviewed. At least 11 enhancing nodular lesions were seen within the wall of the stomach (Fig 2).Abbreviations: H-E = hematoxylin-eosin, MEN-1 = multiple endocrine neoplasia type 1 Figure 1. Upper endoscopic images show a broad-based pedunculated polyp (a) and multiple small sessile polyps (b) in the gastric body. The total number of polyps was not specified in the endoscopy report, but many more polyps were seen at a retrospective review of endoscopic spot images than the 11 polyps identified in the CT report.
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