Differential Diagnosis for Gastric Cancer

The patient's presentation of vague abdominal discomfort, unintentional weight loss, and endoscopy findings of a malignant lesion in the stomach with biopsy results showing infiltrating mostly individual two cells surrounded by desmoplastic fibrosis guides the differential diagnosis.

• Single Most Likely Diagnosis

  • Diffuse-type Gastric Cancer (Linitis Plastica): This type of gastric cancer is characterized by the infiltration of individual cancer cells, often surrounded by a dense fibrotic stroma (desmoplastic reaction), which matches the biopsy description. It typically presents with non-specific symptoms such as weight loss and abdominal discomfort, fitting the patient's clinical presentation.

• Other Likely Diagnoses

  • Intestinal-type Gastric Cancer: Although less likely given the biopsy description, intestinal-type gastric cancer can also present with weight loss and abdominal symptoms. It is more commonly associated with a polypoid or ulcerative mass rather than diffuse infiltration.
  • Gastric Adenocarcinoma with a Poorly Differentiated Component: Some gastric adenocarcinomas may have areas that are poorly differentiated, which could mimic the appearance of individual cells infiltrating the stomach wall. However, these cancers usually have areas of more differentiated adenocarcinoma.

• Do Not Miss Diagnoses

  • Gastrointestinal Stromal Tumor (GIST): Although GISTs are more commonly associated with a mass lesion rather than diffuse infiltration and weight loss, they can occasionally present in a manner similar to gastric cancer. Missing a GIST could be significant due to its different treatment approach, including targeted therapy.
  • Lymphoma: Gastric lymphoma can present with non-specific symptoms similar to gastric cancer and can infiltrate the stomach wall. It requires a different treatment approach, often involving chemotherapy and/or radiation.

• Rare Diagnoses

  • Carcinoid Tumor: These neuroendocrine tumors are less common and can present with a variety of symptoms, including weight loss. However, they are typically associated with a more localized lesion rather than diffuse infiltration.
  • Metastatic Cancer to the Stomach: Rarely, cancers from other sites (e.g., breast, lung, melanoma) can metastasize to the stomach, mimicking primary gastric cancer. The clinical context and biopsy findings would be crucial in distinguishing these cases.