Malignant vs benign gastric ulcer (barium)

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Barium meal has been frequently used to differentiate malignant and benign gastric ulcers:

Features suggesting benign gastric ulcer
  • outpouching of ulcer crater beyond the gastric contour (exoluminal)
  • smooth rounded and deep ulcer crater
  • smooth ulcer mound
  • smooth gastric folds that reach the margin of the ulcer
  • Hampton's line
  • more often along the lesser curvature of stomach, in gastric body and antrum region
Features suggesting malignant gastric ulcer
  • does not protrude beyond the gastric contour (endoluminal)
  • irregular and shallow ulcer crater
  • nodular and angular ulcer mound
  • nodular gastric folds that do not reach the ulcer margin
  • Carman meniscus sign
  • more often along the greater curvature of stomach

NOTE: Remember Hampton's (Harmless = benign) and Carman (Carcinoma = malignant)

Barium studies