Gastric Carcinoma



Gastric Carcinoma


Michael P. Federle, MD, FACR

R. Brooke Jeffrey, MD





Key Facts


Terminology



  • Malignancy arising from gastric mucosa


Imaging



  • Best diagnostic clue



    • Polypoid or circumferential mass with no peristalsis through lesion


  • Best imaging tool



    • Double contrast barium study, NE + CECT, EUS


Top Differential Diagnoses



  • Benign gastric (peptic) ulcer


  • Gastritis


  • Gastric metastases and lymphoma


  • Gastric stromal tumor


  • Caustic gastritis


  • Pancreatitis (extrinsic inflammation)


  • Ménétrier disease


Pathology



  • Risk factors



    • H. pylori (3-6x ↑ risk), pernicious anemia (2-3x ↑ risk)


    • Diet heavy in nitrites or nitrates; salted, smoked, poorly preserved food


Clinical Issues



  • Most common signs/symptoms



    • Anorexia, weight loss, anemia, pain; can be asymptomatic


  • Diagnosis by endoscopic biopsy and histology


Diagnostic Checklist



  • Image interpretation pearls



    • Can be ulcerative, polypoid or infiltrative (scirrhous type) + local and distant metastases






(Left) Axial CECT in a 77-year-old man shows a large mass image infiltrating and thickening the lesser curve from the gastric cardia to the pylorus. Liver image and adrenal image metastases are evident, along with regional lymphadenopathy image. (Right) Axial CECT in the same patient reveals involvement of the splenic vein image, which has resulted in splenic vein narrowing and perigastric collaterals image.






(Left) Axial CECT in a 71-year-old woman with early satiety, weight loss, and loss of appetite shows a distended stomach but a contracted antrum and thickened wall image. Infiltration of the perigastric fat, as well as enlarged lymph nodes image, indicate spread beyond the gastric wall. (Right) A film from an upper GI series in the same patient illustrates the antral constricting mass image and partial outlet obstruction, along with destruction of the mucosal pattern image of the stomach.



TERMINOLOGY


Definitions



  • Malignancy arising from gastric mucosa


IMAGING


General Features



  • Best diagnostic clue



    • Polypoid or circumferential mass with no peristalsis through lesion


  • Morphology



    • Polypoid, ulcerated, infiltrative lesions


Fluoroscopic Findings

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Jun 8, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Gastric Carcinoma

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