Answer to the last #DiagnosticDilemma
The correct answer is D, Metastatic gastric cancer

Gastric cancer (stomach cancer) is the fifth most common malignancy worldwide and is the third leading cause of cancer-related death each year. Stomach cancer is the 4th most common cancer in India with high prevalence rate in Indian men.

The patient's history, physical examination, and abdominal CT scan were concerning for Metastatic gastric cancer.

The liver MRI demonstrated hepatic masses with findings compatible with metastatic disease. The EGD with biopsy revealed a large, submucosal, noncircumferential mass without stigmata of recent bleeding in the gastric fundus.

Pathologic examination of the biopsy sample revealed a poorly differentiated adenocarcinoma. Colonoscopy was unremarkable. An ultrasound-guided, core-needle liver biopsy with imprint cytology also revealed a poorly differentiated adenocarcinoma morphologically consistent with gastric adenocarcinoma.

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