79 Gastric Adenocarcinoma

Clinical Presentation

A 28-year-old man complains of epigastric pain, anorexia, and weight loss.

Fig. 79.1 (A,B) Axial contrast-enhanced CT images of the abdomen show mild enhancement and diffuse increased thickness of the gastric walls; these findings are suspicious for gastric neoplasm, although an inflammatory process cannot be excluded. Multiple hypodense cystic lesions are seen in the liver and both kidneys.

Radiologic Findings

Axial contrast-enhanced computed tomography (CT) images of the abdomen (Fig. 79.1) demonstrate mild and diffuse thickening of the gastric walls. The images from the upper gastrointestinal (GI) series (Fig. 79.2) demonstrate abnormal and persistent narrowing of the distal stomach.

Diagnosis

Gastric adenocarcinoma

Differential Diagnosis

Gastric metastases
Gastritis
Gastric mucosa-associated lymphoid tissue lymphoma
Gastric Crohn disease
Caustic ingestion
Gastric tuberculosis

Discussion

Background

Gastric carcinoma is a deadly disease, with decreasing incidence in the past 50 years in North America and Western Europe owing to the earlier identification at imaging and endoscopy. Currently, the incidence of gastric carcinoma is extremely variable worldwide, with the highest number of cases in Japan, China, Russia, and Eastern Europe (> 30 cases per 100,000); men are usually 2 times more commonly affected than women, with a peak incidence in those ages of 50 to 70 years.

Fig. 79.2 (A,B) Upper gastrointestinal series images (double-contrast barium examination) demonstrate an abnormally narrowed and nondistensible gastric outlet suspicious for gastric malignancy. No discrete ulceration is identified.

Different histologic types have been described: adenocarcinomas (intestinal and diffuse types) account for almost 95% of cases, and lymphomas, leiomyosarcomas, carcinoids, and sarcomas for the remaining 5%. Adenocarcinomas have been classified into four different subtypes: papillary, tubular, mucinous, and signet ring. Almost 30% of gastric malignancies arise from the antrum, 30% from the body, and 40% from the fundus and cardia region.