A 59-year-old woman with a history of breast cancer presents with a complaint of abdominal pain and weight loss.

Fig. 98.1 (A,B) Upper gastrointestinal (GI) study shows a lobulated filling defect in the duodenal bulb (arrow). There is no wall irregularity. (C) CT scan performed in the same patient shows multiple rim-enhancing lesions in the liver, likely representing metastasis with central areas of necrosis. There is an enhancing mass in the antrum of the stomach (arrow). Given the appearance on the upper GI series and the CT appearance, the primary lesion is likely a pedunculated lesion arising from the antrum and herniating into the duodenal bulb.

Pedunculated gastric carcinoid, type III (sporadic subtype)

• Adenocarcinoma of the gastric antrum
  
• Lymphoma
  
• GI stromal tumor (GIST)
  
• Metastatic disease
  
• Giant pedunculated hyperplastic polyp