Malignant Ulcers

Approximately 5% of gastric ulcers are found to be associated with malignancy. Of those, 90% are due to adenocarcinoma, with the remaining 10% divided among lymphoma, sarcoma, and metastases.

Prior to the diagnosis of malignancy, patients are often treated symptomatically for presumed benign disease, however they fail to improve. Radiographic imaging suggestive of malignancy warrants tissue biopsy. Once the diagnosis of malignancy is established, surgical resection is indicated.

Radiographic Features:

• Location is predictive of malignancy:

• Shape: The ulcer crater is irregular and nodular

• Non-penetrating: The ulcer does not project beyond the expected normal stomach margin

• Mucosal Folds: Do not radiate to the ulcer margin and are often nodular or fused

• Ulcer mound: Irregular and mass-like with eccentric crater

• Carman Meniscus Sign: Curvilinear lens-shaped intraluminal crater with convexity of crescent toward gastric lumen (this sign appears only with manual graded compression of the stomach during examination)