Bad breath and weight loss

Clinical presentation

A 60‐year‐old man presented complaining of halitosis associated with epigastric discomfort, decreased appetite and weight loss in the previous month. His medical history was unremarkable. A pale conjunctiva and epigastric tenderness were found on physical examination. Laboratory examination revealed microcytic anaemia (haemoglobin 12.2 g/dl; mean corpuscular volume 77.6 fl). Upper endoscopy was arranged because of the possibility of malignancy. On endoscopic examination, the oesophagus and the duodenum were unremarkable. A lesion was found in the stomach (fig 1), so subsequently a CT scan of the abdomen was performed (fig 2).

Figure 1 Endoscopic image of the stomach.

Figure 2 Abdominal CT of the patient.

Question

What is the diagnosis?

See page 829 for answer