What happened, in summary

A 43-year-old man was referred for evaluation after months of increasing fatigue, fever, poor appetite and weight loss. He also had nausea, fullness after meals and occasional upper-abdominal discomfort. Examination showed anemia and striking thickening and darkening of both palms with a velvety appearance, a finding known as tripe palms and sometimes associated with internal cancer.

Blood testing confirmed significant anemia, and a stool test was positive for occult blood. Because the combination of gastrointestinal symptoms, anemia and the unusual palmar skin changes raised concern for an underlying malignancy, he underwent upper endoscopy. This showed an irregular mass in the stomach. Biopsy confirmed gastric adenocarcinoma.