A 64-year-old man presented to the PC clinic with a two-month history of dry cough and occasionally a feeling described by the patient: as if he had "closed the pylorus" and could not eat.
His mother and father died from tuberculosis (TB) as family history.
As personal history there were: poliomyelitis in childhood that left as a sequel a mild deformity in both lower limbs, duodenal ulcus at 35 years without posterior peptic clinic and inguinal herniorrhaphy in 1997.
Ex-smoker for 9 years.
In the anamnesis, he initially complained of recurrent heartburn lasting minutes, which resolved spontaneously or with antacids, and also a feeling of gastric fullness.
Physical examination revealed an asthenic habit.
She was afflicted, eupneic and normocolored.
The examination of the head, neck, chest and abdomen was normal.
At the first visit, the family physician requested basic laboratory tests (physical examination and biochemical tests) and chest X-ray (Rx), and empirical treatment with 20 mg/day was initiated.
The results of the complementary tests were strictly normal and the empirical treatment was not effective.
At the same time, the patient consulted an otorhinolaryngologist on his own initiative, who requested a X-ray of the paranasal sinuses, finding compatible with sinusitis, which was treated by the specialist with a Cefurlo cycle (6-hax 500 mg).
Subsequently, one month later, in view of the persistence of cough and recent onset of mild weight loss, his family physician requested consultation with a pneumologist, performed an extended laboratory test and a fecal occult blood test.
The complementary tests performed by the pulmonologist were: mantoux, which was positive (12 mm) with repeatedly negative sputum hplc, thoracic methacholine test, computed tomography (CTF) and lung function tests (PFTC).
All these tests did not yield pathological findings.
Empirical treatment with bronchodilators was also not effective by the pulmonologist.
The new complementary tests performed by the family physician resulted in mild anemia (Hb: normocytic albumin g/dl) normocytic with high erythrocyte distribution index, thrombocytosis, increased erythrocyte sedimentation rate.
The fecal occult blood test was positive.
With this new finding, his family doctor consecutively requested an interconsultation with a gastroenterologist who performs a seizure and an opaque enema in the only significant finding without evidence of digestive tract disease, showing another colonic pathology.
Simultaneously to the follow-up of the digestive picture, 3 weeks after consultation with the pneumologist, the patient begins, with asthenia, so his family physician requested consultation with the Internal Medicine Department of the hospital.
In this service an abdominal CT is performed in which a large abdominal tumor with probable gastric organ dependence and local involvement is observed, which recommend confirmation by gastroscopy and biopsy.
When performing oral panendoscopy, they found a gastric ulcer with a prepyloric appearance which was later confirmed by pathological anatomy of a biopsy specimen.
The Department of General and Digestive Surgery performed an exploratory laparotomy finding a large tumor, probably retroperitoneal, adhered to the posterior gastric fundus level and multiple extraperitoneal nodules.
Several of these nodules were removed for biopsy and partial gastrectomy with gastrojejunostomy was performed.
The biopsy is reported as intermediate grade fusocellular sarcoma (grade II) in a stromal sarcoma of the gastrointestinal wall.
With this diagnosis internal medicine consultations were disregarded for evaluation of adjuvant treatment.
After hospital discharge, the patient received palliative home care by his family physician until his death, 14 months after diagnosis.
