Menetrier's disease (MD) or polyadenomes en
nappe is a form of hypertrophic gastropathy occurring primarily in middle-aged males. Patients generally present clinically with
dyspepsia and, on occasion, with hypoproteinemic
edema and
anemia. The latter feature, when combined with the radiographic appearance of the stomach in MD, can lend to
confusion with
carcinoma and
malignant lymphoma. To illustrate this diagnostic problem, a case is reported of a 41-year-old female who initially presented to her family physician with symptoms of easy
fatigue and
dyspnea on exertion and signs of pallor and ankle
edema. Pertinent laboratory findings included a
hemoglobin of 2.8 g/dL, hematocrit of 10.3 percent, mean corpuscular volume of 63.4 mu 3, a
serum albumin of 2.7 g/dL, and
heme positive stools. Endoscopic examination revealed a circumferential polypoid mass involving the cardia and fundus of the stomach with relative sparing of the antrum. A CT scan of the abdomen and pelvis showed a large mass in the stomach which the radiologists and gastroenterologists believed probably represented a
lymphoma or gastric
carcinoma. A total
gastrectomy specimen exhibited features of MD. Routine bright-field microscopy and immunohistochemical reactivity for
transforming growth factor-alpha confirmed the diagnosis of MD. Moreover, ulceration of the
tips of some of the hypertrophied gastric folds provided an explantation for the
iron deficiency anemia. Awareness that MD may present with
anemia will help in the differential diagnosis with
lymphoma and
carcinoma.