Gastric cancer Quiz: Ace Your Exams

An 80-year-old man presents to the primary care physician with a chief complaint of a new rash that suddenly appeared several days ago. He reports the rash is not itchy, and he has not had a similar rash in the past. When questioned further, the patient reports a several-month history of abdominal pain, weight loss, early satiety, and fatigue. He reports discomfort in the mid-epigastrium postprandially that started one year ago and has worsened. The patient took a proton pump-inhibitor, which initially alleviated the pain but now has no effect on symptoms. He has lost 9.1-kg (20-lb) over the past six months. Further past medical history includes coronary artery disease, hypertension, recurrent H. pylori gastritis, and a twenty one pack year smoking history. Physical examination shows multiple seborrheic keratoses on his chest and back, as well as temporal wasting. Multiple enlarged supraclavicular lymph nodes are noted, predominantly on the left side. Laboratory results reveal a hemoglobin level of 8.0 g/dL and mean corpuscular volume of 70 fL. Which of the following findings is most likely to be present on endoscopic evaluation?