Option D: This smoothly marginated, partially exophytic, gastric mass is most consistent with a gastrointestinal stromal tumor (GIST).

GIST is a mesenchymal tumor that arises from the gastric wall and is often indolent and asymptomatic.
Occasionally, these tumors may be ulcerated and/or hemorrhagic. GIST is most often seen in adults over age 40.

Other options

Option A: Although adenocarcinoma is a common primary gastric mass, it is mucosal in origin. Larger masses are typically ulcerated and heterogeneous, growing concentrically along the gastric wall, unlike the test case. It is an aggressive tumor and can be seen on CT either as a heterogenous polypoid mass, ulceration, or focal wall thickening with mucosal irregularity, unlike the presenting CT.

Option B: Linitis plastica is a term that refers to a diffuse infiltrative process of the gastric wall, usually involving the submucosa. This is a descriptive term rather than a pathologic diagnosis and may be due to either neoplastic or inflammatory causes. The underlying cause is usually a scirrhous adenocarcinoma(signet ring cells are seen) with diffuse submucosal infiltration, leading to thickening and rigidity to the stomach wall. CT shows a diffusely thickened stomach with a small lumen.

Option C: Breast cancer metastases might occur in the stomach. However, an isolated large homogeneous gastric mass would be very unlikely for breast cancer. Metastases are rare in the stomach. Metastatic breast cancer may spread through a hematogenous route resulting in small intramural masses, usually multiple, that are indistinguishable from benign disease which is unlikely in the given image. Besides, no information is given in the question about the primaries which are easily localized in breast cancer, ruling out its possibility.

Reference: Brant and Helms Fundamentals of Diagnostic Radiology. 5th edition. Page. No. 1172

A-https://radiopaedia.org/articles/gastric-adenocarcinoma?lang=us

B-https://radiopaedia.org/articles/linitis-plastica?lang=us

C-GRAINGER & ALLISON’S DIAGNOSTIC RADIOLOGY. 6th edition. Page No. 645

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