Case: AP110
Contributor's Comment: The correct patient information should be F/61. Endoscopy showed the typical appearance of linear broad erythematous stripes traversing the antral mucosa (watermelon stomach), and biopsy was taken over reddish streaks. GAVE is an acquired abnormality of the gastric antral mucosa, typically affecting elderly women. Some cases may be related to mucosa trauma or prolapse, but in most instances the cause is unknown. The basic abnormality is dilatation and bleeding of the superficial mucosal capillaries. There may be no gross abnormality detected in the gastrectomy specimen, because any dilated vessels collapse when transected. Microscopically, dilated capillaries are present in the superficial lamina propria immediately beneath the epithelial surface. These changes are often subtle and difficult to distinguish from normal capillaries which may also appear engorged with blood. However, in GAVE the capillaries are usually larger in diameter that normal and have thicker walls with surrounding fibrohyalinosis. They may contain fibrin thrombi. Fibromuscular hyperplasia of the lamina propria is present.

The differential diagnosis includes Osler-Weber-Rendu disease, arteriovenous malformations, and vascular ectasia secondary to portal hypertension. In Osler-Weber-Rendu disease, typically additional telangiectasias are present in the mouth and on the face. Portal hypertension produces lesions in the gastric fundus rather than the antrum. Arteriovenous malformations usually involve larger calibre vessels than GAVE and are usually in the form of circular patches.

Participants who diagnosed the presence of concomitant gastritis are deducted 5 marks. One participant preferred a multiple-choice format for this QAP. There are different ways of running a QAP. ASCP and CAP adopt a multiple-choice format and a feedback with answers and case discussion. RCPA adopts a daily reporting format (including microscopic description) and a feedback with answers and degree of acceptability of participants' returned diagnoses. Our QAP also simulates daily reporting and is uniquely feedbacked with a score. If the participant finds no abnormality, just simply return a diagnosis "No pathological diagnosis", as one would do in daily reporting.