CASE HISTORY

The patient was a typical case of acromegaly of four years duration. On the day of admission she suddenly passed into coma. On admission she was deeply comatose but with no definite nervous sign other than a bilateral extensor plantar response. Heart enlarged. B.P. 230/140. Vessels thickened. Eyes showed bilateral papilloedema with thick vessels and retinal haemorrhage. Patient died with 24 hours of admission.

PATHOLOGY

The specimen consists of the resected part of stomach with a window cut out of the anterior wall exposing a large deep ulcer at the lesser curvature, about 1 1/2 x 2cms in diameter and about 1 1/2cms deep. The floor of the ulcer shows dense fibrosis and thickening, and this fibrosis continues to some extent into the surrounding tissues. The wall of the ulcer projects into the stomach cavity, causing some slight narrowing of the lumen. The rest of the mucosa is atrophic and shows congestion and some small haemorrhages, but there are no other large ulcers to be seen. The serous coat also shows congestion and haemorrhages, probably due to trauma at operation.