Case History/examination
64-year-old male farmer with elementary education, living in one of the villages of Zanjan, one of the central provinces of Iran, visited the specialized surgery clinic of our center 9 months ago with a complaint of vague abdominal pain dominantly in the epigastric area. He had lost more than 10 kg of weight during this period, and in the last month, he mentioned symptoms such as loss of appetite, weakness, and lightheadedness. The pain was continuous and was not related to eating, physical activity or physical position. The patient did not mention nausea and bowel pattern was normal. The patient had been under treatment with metformin 1 gram daily for the past 5 years due to diabetes and had no history of other disease or medication. The patient had no history of surgery, alcohol use, smoking, or opium consumption, and did not mention any medication or food allergy. The patient’s brother had a history of colorectal cancer and there was no history of any other significant diseases in the first degree family members. On physical examination, vital signs and general appearance were normal. Abdominal exam did not find anything abnormal. Also, general physical exam did not contain any pathological findings.