Question

Consider the following. Upper gastrointestinal endoscopy may reveal smooth mucosa in:

1. Linitis plastica
2. Lymphoma of stomach
3. Stromal tumour
4. Chronic atrophic gastritis

Which of these are correct?

• A. 1 and 4
• B. 1 and 3
• C. 2 and 4
• D. 1, 2, 3 and 4

Hint:

Think about which lesions stay under the mucosa versus which ones tend to break through and ulcerate it.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The question lists four gastric conditions and asks which of them can show a smooth, rather than ulcerated or nodular, mucosal surface when viewed at upper GI endoscopy.

Step 2: Key Concept or Approach:
Endoscopy visualises only the surface mucosa. A lesion that is primarily submucosal or that diffusely thickens the wall without breaching the epithelium can leave the overlying mucosa looking smooth and largely intact, even though deeper biopsies show significant disease. A lesion that predominantly affects the mucosa itself, or that tends to ulcerate as it grows, is more likely to look irregular or eroded on endoscopy instead.

Step 3: Working Through the Options:
Gastric lymphoma frequently infiltrates the gastric wall submucosally and can spread widely while the mucosal surface over it stays smooth and only diffusely thickened, which is a recognised reason superficial endoscopic biopsies can under-sample and miss the diagnosis. Chronic atrophic gastritis flattens and effaces the normal rugal folds as the glands atrophy, so the mucosa looks thin, pale, and smooth rather than showing the usual rugose pattern, with submucosal vessels sometimes visible through it. Linitis plastica does infiltrate the stomach wall diffusely and can rigidify it, but it commonly shows patchy mucosal change such as erythema, ulceration, or nodularity rather than a uniformly smooth surface, which is exactly why endoscopic biopsy yield in linitis plastica is notoriously poor. A gastrointestinal stromal tumour usually presents as a discrete submucosal bulge, and once it outgrows its blood supply it very often ulcerates centrally, giving an umbilicated rather than a uniformly smooth appearance. Taking these features together, lymphoma of the stomach and chronic atrophic gastritis are the two conditions most consistently associated with a smooth endoscopic mucosal appearance.

Step 4: Conclusion:
The correct combination is gastric lymphoma and chronic atrophic gastritis.