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Findings: 1) There is thickening extending from the gastric fundus along the greater curvature of the stomach. 2) Extending to the margin of the greater curvature are areas of increased attenuation and stranding extend into the adjacent mesentery. Inferior to the stomach and duodenum there is thickening of the mesentery and stranding. 3) There is a focal, complex low-density inferior to the stomach and anterior to the duodenum with foci of air consistent with small contained perforation and abscess formation. In the area near the pancreatic tail there is a second focus also likely representing perforation and abscess formation. This is less well demonstrated. 4) There is fluid in the anterior pararenal spaces bilaterally. 5) There are nonspecific lymph nodes present. These extend for example as inferior as the LEFT lower quadrant anterior to the colon on image 67.
Diagnosis: 1) Gastric carcinoma with extraserosal extension, 2) Peritoneal carcinomatosis, 3) Contained perforations
File:3C
Organ system: 3.0 GI Tract
Organ: C. – stomach.
Etiology and incidence 1) Most common form of gastric carcinoma is adenocarcinoma. 2) Second most common cause of cancer dense worldwide though less prominent in the United States. In the United States this accounts for approximately 2 to 3% of all newly diagnosed cancer yearly. 3) This is much more common in males than females. 4) Age is typically greater than 50 years old. 5) Risk factors include a; Helicobacter pylori infection. b; Diet – possibly accounting for increased incidence in Japan, Chile and Iceland c; History of gastric polyp greater than 2 cm d; Chronic gastritis and atrophic gastritis e; Pernicious anemia f; Alcohol and tobacco use g; Family history.
Diagnosis 1) CT: a; Associated with the stomach, there is asymmetric or symmetric wall thickening with or without enhancement, ulceration, focal mass which may be polypoid or lobulated b; Spread is by focal extension and metastasis to the liver, peritoneum and mesenteric lymph nodes. 2) Fluoroscopy: a; Findings range from polypoid lesions to lobular masses to diffuse gastric wall thickening with or without ulceration. B; Linitis plastic. 3) PET CT a; Hypermetabolic activity within the primary tumor as well as within distant metastases, peritoneum and lymph nodes. 4) Differential diagnosis: a; Gastritis and Menetrier’s Disease. B; Benign gastric ulcers. C; Pancreatitis with associated gastric wall inflammation. D; Lymphoma e; Metastasis – melanoma, breast, colon. F; Leiomyosarcoma and gastric leiomyomatosis.
Prognosis/Clinical 1) Symptoms: a; Gastric cancer frequently presents late in its course. Symptoms are frequently associated with bleeding and metastasis. B; Bright red blood per rectum or dark tarry stools. Hematemesis. C; Weakness and fatigue. D; Nausea and vomiting. Difficulty swallowing. E; Ascites. 2) Prognosis: a; In early stages, gastrectomy can improve outcomes. This is particularly true for more distal gastric carcinoma. More proximal carcinoma involving the gastroesophageal junction area carries a lower prognosis. B: Most, up to 90%, develop metastasis. 6 months survival in general is approximately 66% in early stages with less than 20% survival in later stages. Overall 5 year survival is less than 20%. Overall average survival is less than 1 year. C; Treatment is typically multi-modality with surgery, radiation and chemotherapy.
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Supplemental Tables
Helicobacter pylori gastritis mimicking gastric carcinoma at CT evaluation. Radiology June 1991 179:689-691
…majority of abnormalities involved the gastric antrum (68%). No cases demonstrated…Helicobacter pylori gastritis mimicking gastric carcinoma at CT evaluation. | The abdominal…biopsy. Of 19 patients (31%) with gastric abnormalities at CT, 14 (74%) had…
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Metastasis to Regional Lymph Nodes in Patients with Esophageal Squamous Cell Carcinoma: CT versus FDG PET for Presurgical Detection— Prospective Study Radiology June 2003 227:764-770; doi:10.1148/radiol.2281020423
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Detection of Hepatic Metastases from Cancers of the Gastrointestinal Tract by Using Noninvasive Imaging Methods (US, CT, MR Imaging, PET): A Meta-Analysis Radiology September 2002 224:748-756; Published online July 12, 2002, doi:10.1148/radiol.2243011362
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CT and PET in Stomach Cancer: Preoperative Staging and Monitoring of Response to Therapy Radiographics January-February 2006 26:143-156; doi:10.1148/rg.261055078
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National Cancer Institute. Gastric cancer treatment PDQ. Updated July 8, 2010.
