Radiological Category Gastrointestinal Principal Modality 1 Fluoroscopy Principal

Case History 35 year-old Hispanic male with long-standing history of epigastric pain with gradual

Radiological Presentations CT Abdomen, Soft Tissue Window

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: UGI: Thickened and irregular rugal folds in the gastric fundus

Discussion Gastric Adenocarcinoma: Accounts for 95% of all primary gastric carcinomas. Affects males twice

References Balfe D. et al. Computer Tomography of Gastric Neoplasms. Radiology. 1981; 140: 431

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Radiological Category: Gastrointestinal Principal Modality (1): Fluoroscopy Principal Modality (2): CT Case Report #0419 Submitted by: Nicholas Beckmann, M. D. Faculty reviewer: Michael Redwine, M. D. Date accepted: 14 April 2007

Case History 35 year-old Hispanic male with long-standing history of epigastric pain with gradual weight loss and early satiety developing over the past several months.

Radiological Presentations UGI Series

Radiological Presentations CT Abdomen, Soft Tissue Window

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Gastric Adenocarcinoma • Lymphoma • Gastric sarcoma • Metastatic adenocarcinoma, particularly breast cancer

Findings and Differentials Findings: UGI: Thickened and irregular rugal folds in the gastric fundus and body. Circumferential narrowing of the gastric antrum which remains unchanged throughout study. Findings consistent with linitis plastica of the gastric antrum. Abdominal CT: Diffuse thickening of the gastric antrum wall and narrowing of gastric lumen, no areas of necrosis in mass. Enlarged gastroepiploic and peripancreatic lymphnodes. Differentials: • Gastric adenocarcinoma • Lymphoma • Gastointestinal Stromal Tumor • Metastatic breast adenocarcinoma

Discussion Gastric Adenocarcinoma: Accounts for 95% of all primary gastric carcinomas. Affects males twice as frequently as females. Strong association with H. pylori, dietary nitrates, hypochlorhydria & cigarette usage. Most common cause of linitis plastica. Lymphoma: Rarely causes linitis plastica. Patients typically have history of lymphoma or evidence of diffuse lymphoma at time of gastric involvement. Gastrointestinal Stromal Tumor: Peak age of incidence is 40 -70. Tumor frequently is necrotic with metastases to liver at time of diagnosis. Metastatic breast adenocarcinoma: Only 1% of breast cancer cases occur in males with the median age at diagnosis being 67 years of age.

Diagnosis Gastric Adenocarcinoma

References Balfe D. et al. Computer Tomography of Gastric Neoplasms. Radiology. 1981; 140: 431 -436 Hassan I. Gastric Cancer. e. Medicine. com. Oct. 19, 2006 Levine M. et al. Non-Hodgkin’s Lymphoma of the Stomach: A Cause of Linitis Plastica. Radiology. 1996; 201: 375 Nazareno J. Taves D. Preiksaitis HG. Metastatic Breast Cancer to the GI tract: A case review series and review of the literature. World J Gastroenterol. 2006; 12: 6219 -24 Nguyen V. Taylor A. Gastrointestinal Stromal Tumors- Leiomyoma/ Leiomyosarcoma. e. Medicine. com. Dec. 1, 2004 Roubidoux M. Patterson S. Male Breast Cancer. e. Medicine. com. Feb. 2, 2005