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Unexpected finding
  1. Natalia G Vallianou1,
  2. Nikolina Stavrinou2,
  3. Fotis Panagopoulos1,
  4. Eleni Geladari1,
  5. Alexandros G Sykaras2,
  6. Christine Vourlakou2
  1. 1 Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
  2. 2 Department of Pathology, Evangelismos General Hospital, Athens, Greece
  1. Correspondence to Dr Natalia G Vallianou, Evangelismos General Hospital, Athens, Greece; natalia.vallianou{at}

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Clinical question

Herein, we describe an 81-year-old female patient, who presented with pancytopenia and bacteraemia due to Escherichia coli infection. Her pancytopenia continued despite complete response of the bacteraemia. The patient underwent a bone marrow biopsy as well as agastroscopy that revealed an ulcer. Biopsies were obtained and the findings are depicted in figure 1.

Figure 1

(A–C): Diffuse neoplastic infiltration of the gastric mucosa of antrum and body, from a high-grade poorly differentiated neoplasm with marked cytological and nuclear atypia ((A) H&E staining ×100, (B) H&E staining ×200, (C) H&E staining ×400). (D) Neoplastic cells were E-cadherin negative (×400 magnification). (E) Tumour cells showed strong oestrogen receptor positivity (×200 magnification). (F) GATA3 expression in tumour cells (×400 magnification).

Which of the following answer is correct?

  1. Gastric adenocarcinoma poorly cohesive or signet-ring cell subtype.

  2. Lobular breast carcinoma. …

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  • Handling editor Iskander Chaudhry.

  • Contributors NGV reviewed and submitted the virtual case. EG and FP have written the discussion section, while NS, AGS and CV were responsible for the figure, its description and the differential diagnosis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.