A female, aged nineteen, of robust appearance, had enjoyed good health until twelve months ago, when she had an attack of herpes zoster on the left side. A short time afterwards she began to suffer from distension of the stomach and pain after meals. At first the pain was only slight and occasional, but subsequently it became very bad, and was especially troublesome at night. For the last three months she had lost much flesh-a stone and a half in six weeks. She often felt faint with the pain in the stomach, which had also extended to the left side. The bowels were regular. One day, while going about her usual work, she suddenly felt faint and vomited a small tumour. At the time of its rejection another appeared to be rising in her throat, but she swallowed it again. After the emesis she felt poorly all day, and on several occasions ejected a small quantity of blood. The tumour itself was about the size of a chestnut, and appeared to have been attached by a small pedicle to the mucous membrane of the stomach. It was firm and looked like an unshelled egg. The cut surface showed several small foramina, and on microscopical examination it was found to consist of connective tissue, blood-vessels, and granular cells, covered by a layer of mucous membrane.-Beardsley.
Haemorrhage occurs in about 10 per cent, of the cases. When it is due to excessive vascularity of the growth or of the surrounding mucous membrane, the vomit is merely tinged with blood, or exhibits a slight coffee-ground appearance; but when a large vessel has been eroded by ulceration or sloughing of the tumour the loss of blood may be serious and recurrent (Rondeau, Ellison).
Large adenomata are always accompanied by important gastric symptoms. If, as is usually the case, the tumour occupies the pyloric region of the stomach, pain after food, with flatulence, acidity, and vomiting, are the chief causes of complaint ; and should the pyloric orifice ultimately become obstructed, periodic attacks of emesis, accompanied by loss of flesh, anorexia, and cachexia, gradually make their appearance, and, unless the disease proves amenable to treatment, eventually lead to a fatal issue. When the central portion or the fundus is the seat of the disease, there is usually severe pain after food ; vomiting and hsematemesis, or melaena, occur from time to time, and the patient develops the emaciated and cachectic appearance which is usually indicative of a cancerous growth.