Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Resident : kimiya mohammadi
Gender : Male
Age : 56
A 56 years old man with history of gastric cancer
CT scan shows lung metastases, hepatic metastases, peritoneal thickening in anterior abdominal wall and multiple calcification lesions are seen portahepatitis and retrocrural.
Mucinous adenocarcinoma of the stomach with metastases
Discussion (Related Text)
Gastric adenocarcinoma assumes four common morphologic growth patterns. One third are polypoid masses that present as filling defects within the gastric lumen. Another third are ulcerative masses presenting as malignant gastric ulcers. The remainder are infiltrating, presenting as scirrhous carcinomas or superficial spreading. Scirrhous carcinoma is characterized by diffuse infiltration of the gastric wall by poorly differentiated or undifferentiated carcinomatous cells. The wall of the stomach is thickened and rigid. The terms linitis plastica and water-bottle stomach may be applied to describe the resulting stiff, narrowed stomach. Superficial spreading carcinoma spreads through the mucosa and submucosa, producing nodular thickening or superficial mucosal ulceration. Gastric adenocarcinomas are most common near the cardia (44%), in the antrum, and along the lesser curvature. The tumor spreads by direct invasion through the gastric wall to involve perigastric fat and adjacent organs, or it may seed the peritoneal cavity. Lymphatic spread is to regional lymph nodes, including perigastric nodes along the lesser curvature, celiac axis, and hepatoduodenal, retropancreatic, mesenteric, and paraaortic nodes. Hematogenous metastases involve the liver, adrenal glands, ovaries, and, rarely, bone and lung. Intraperitoneal seeding presents as carcinomatosis or Krukenberg ovarian tumors. CT and MR are used to determine the extent of tumor to facilitate preoperative planning. Findings include (1) focal, often irregular, wall thickening (>1 cm); (2) diffuse wall thickening as the result of tumor infiltration (linitis plastica) (contrast enhancement is common); (3) intraluminal soft tissue mass; (4) bulky mass with ulceration; (5) rare, large, exophytic tumor resembling leiomyosarcoma; (6) extension of tumor into perigastric fat; (7) regional lymphadenopathy; and (8) metastases in the liver, adrenal, and peritoneal cavity. Mucinous adenocarcinomas frequently contain stippled calcifications.
Brant WE, Helms CA. Fundamentals of Diagnostic Radiology, 4rd edition