Menetrier’s Disease Masquerading as Adenocarcinoma of Stomach

Abstract

Sir Ménétrier’s disease (MD), a hypertrophic hypoproteinemic gastropathy, is an uncommon acquired condition distinguished by large rugal folds in the body and fundus of the stomach, frequently with antral sparing, reduced acid secretion, protein loss with hypoalbuminemia, and raised mucus production. Men are more frequently affected, and the usual age at diagnosis is between the third and sixth decade. Usually, diagnosis is straight forward; sometimes, may masquerade with features of adenocarcinoma of the stomach, making the diagnosis preoperatively challenging, and patient may receive unnecessary treatment. Awareness and knowledge of this entity can help clinicians and pathologists exclude this condition carefully and make a diagnosis correctly. A 40-year lady presented with pain in the abdomen, was evaluated at a dedicated gastrointestinal institute, and was found to have a polypoidal mass in the body of the stomach and projecting into the lumen on upper gastrointestinal endoscopy. Biopsy revealed features suspicious of well-differentiated adenocarcinoma. A slide review at our institute too confirmed the above findings. A contrast CT scan of the abdomen revealed enhancing polypoidal mass involving the body of the stomach. Multiple suspicious nodes were found in hepatogastric, perigastric, and short gastric regions. A diagnosis of locally advanced adenocarcinoma of the stomach was made and was planned for neoadjuvant chemotherapy and then reassessment for surgery. Before that, she had melena requiring three units of blood transfusion and subsequently taken for surgery. She underwent a middle gastrectomy with D2 nodal dissection with preservation of gastroepiploic arcade. The specimen showed gastric mucosa showing hypertrophy with giant gastric rugae. Intraoperative frozen section analysis for margin status revealed superficial adenocarcinoma of stomach infiltrating lamina propria with proximal and distal margin free of tumor. The final histopathology revealed Ménétrier’s disease of the stomach with no evidence of cancer. We describe the histopathological details and discuss the point of pretense.