CT abdomen and pelvis
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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.
2 case question available
This patient went on to have a total gastrectomy after the stomach tumour was identified on gastroscopy.
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
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Heaped-up margins of the mass (blue arrows) with central ulceration (pink arrow).
1 case question available
This tumor 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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