Benign versus malignant gastric ulcers

Can benign and malignant gastric ulcers be distinguished? 

Imaging features allow an estimate of the likelihood of malignancy. A malignant or possibly malignant appearance warrants endoscopy and biopsy.

For unequivocally benign radiographic features, radiologic follow-up is a less costly and less invasive alternative. If features equivocal for malignancy develop during follow-up or if healing fails despite adequate medical therapy, endoscopy and biopsy are indicated.

Gastric Ulcers on Upper Gastrointestinal Series: Benign and Malignant Features

Location in stomachOther than upstream half of stomach along greater curvatureUpstream half of stomach along greater curvature
Profile view: relationship of ulcer to lumenBeyond expected lumenWithin expected lumen
Radiating foldsRegular
To margin of ulcer or to ulcer mound (of edema)
Nodular, irregular, fused, clubbed, or amputated
May not reach ulcer margin
If ulcer is within a massUlcer location in mass: central
Mass: smooth
Junction with wall: obtuse angle
Ulcer location in mass: eccentric
Mass: irregular
Junction with wall: acute angle
Surrounding mucosaIntactDistorted or obliterated
Ulcer shapeRound, oval, or linearAngular
OtherHampton line
HealingCompleteUsually incomplete
Occasionally complete, but scar
Radiating folds with malignant characteristics

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