Radiology Resident Case of the Week
Etiology/Pathophysiology
Gastric Carcinoma was the most common malignancy in the US in the 1940's. This has dramatically decreased over the past few years as has the incidence of gastric cancer in most other countries including Japan. Japan and Columbia do still have a much higher incidence of Gastric CA than other countries.
Studies also suggest that exposure to an etiologic agent at an early age may be responsible for gastric CA. This agent however has not been found.
It is more plausible that dietary factors may be responsible. Gastric CA appears to be associated with the following diets: high salt intake, low fat and protein, high complex carbohydrates, high nitrates, and low green, leafy vegetable and fruit intake.
Pathology:
The majority of carcinomas of the stomach are adenocarcinomas which arise from mucin producing cells. These lesions are considered local when they are limited to the mucosa and submucosa. Tumors which extend into the muscularis are considered advanced.
More recently gastric CA has been divided into expanding and infiltrative forms. The expanding CA's are characterized by a cohesive mass, while the infiltrative form has no cohesive mass and is more poorly defined and diffuse.
Miscellaneous
Imaging
The above images demonstrate a superficial irregular ulcer lacking edema. The folds leading to the ulcer are irregular and interrupted. This is typical for a early superficial Gastric CA.
DDX
The Differential dx is that of benign versus malignant.
Features that suggest a benign lesion include an ulcer collar line( line line of edema), regular appearing folds radiating to the ulcer crater, Hampton's line(healing, undermining of the ulcer crater), and the penetration of the ulcer beyond the gastric wall.
Criteria that suggest malignancy include: Negative filling of the crater, mass, irregular shape, and irregular gastric folds which are often interrupted when leading to the ulcer.
Key references
Gastrointestinal Disease. Sleisenger and Fordtran.
Robbins Textbook of Pathology
ACR Code
Keywords:
ulcer, gastric carcinoma