This A 56-year-old white female was admitted to the hospital with a six-year history of severe epigastric pain and burning. This pain , which has occurred intermittently for the Last 4 years was said to be worse at night and on an empty stomach. The patient reported that the pain was relieved by drinking milk. She had also experienced several episodes of hematemesis and melena since the onset of the pain, the last episode occurring 3 weeks prior to admission. The patient described intermittent episodes of colicky pain An upper endoscopy was performed which demonstrated an ulcer in the right upper quadrant and right side of the abdomen, frequently radiating to the back and shoulders and often accompanied by "bilious vomitinggastric mucosa." Physical examination A breath test for Helicobacter pylori was noncontributory except for tenderness in positive so the epigastrium patient was started on antibiotics and right upper quadrantproton pump inhibitors (PPI). An upper GI series showed changes suggestive of  Autopsy pictures and histology sections from a neoplasm. The different patient submitted to an abdominal exploration at which time a partial gastrectomy was performedwith peptic ulcer disease are presented.