Gastric adenocarcinoma

Case contributed by A.Prof Frank Gaillard

Presentation

Melaena

Patient Data

Age: 85 years
Gender: Male
CT

CT abdomen and pelvis

CT of the abdomen demonstrates a mass arising from the greater curvature of the body of the stomach. It is centrally ulcerated with locules of gas and contrast seen within it, but without evidence of perforation. It is a focal abnormality with thick heaped-up shoulders. 

At the splenic hilum there appears to be an enlarged lymph node (this should be confirmed on thin slice and coronal reformats). No convincing evidence of metastatic disease. 

The left kidney is atrophic and contains a number of what appear to be hyperdense cysts (which should be confirmed on ultrasound). The right kidney has a large simple cyst. 

This patient went on to have a total gastrectomy after the stomach tumour was identified on gastroscopy. 

HISTOLOGY

MACROSCOPIC DESCRIPTION: The specimen is a total gastrectomy. Arising from the body of the mucosa at the  anterolateral aspect is a large friable tan centrally ulcerated round polypoid tumour mass 65 mm in diameter with markedly heaped up edges. At the  site of  the tumour  the serosal  surface shows marked indrawing,  roughening and  there is adherent fat.   Macroscopically the tumour  appears to extend through the wall to the serosal surface.  

MICROSCOPIC DESCRIPTION: The tumour is  adenocarcinoma with  abundant gland  formation and mucin secretion  (so-called intestinal  type).  It  infiltrates  through the full thickness of stomach wall into adjacent  fat.  The surface is ulcerated and covered  by  abundant  necrotic  and  inflammatory   debris  with  abundant bacteria.  Focally the  tumour cells infiltrate as  large solitary atypical cells and although the bulk of the  tumour is moderately differentiated, at worst the tumour is  considered poorly differentiated.

DIAGNOSIS: moderately and focally poorly differentiated adenocarcinoma

Annotated image

Annotated image

Heaped-up margins of the mass (blue arrows) with central ulceration (pink arrow). 

Case Discussion

This tumour demonstrates typical features of a large stomach adenocarcinoma, with heaped up edges and central ulceration, which is a feature of up to 70% of gastric adenocarcinomas. 

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Case information

rID: 15047
Case created: 18th Sep 2011
Last edited: 7th Nov 2017
Tag: stomach
Inclusion in quiz mode: Included

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