Gastric adenocarcinoma

Case contributed by Shervin Sharifkashani
Diagnosis almost certain


Epigastric pain, chest pain, and weight loss for five months.

Patient Data

Age: 55 years
Gender: Male

Diffuse infiltrative mucosal-mural mass lesion thickness up to 35 mm in gastric proximal to middle segment more prominent in lesser curve and the cardia and submucosal extension within gastric antrum extended within perigastric fat in some parts is seen.
Ill-defined solid mass axial width up to 25 x 22 mm within pancreas tail is seen which can be metastatic mass lesion.
Metastatic lymph nodes with SAD up to 12 mm in the left side upper paraaortic and SAD up to 10 mm in gastro-hepatic ligament are seen.
Free fluid in the pelvic cavity compatible with malignant fluid is noted.
A few small dense Gallbladder calculi are also seen.

Case Discussion

The case illustrates the contrast-enhanced features of the pathology-proved Gastric adenocarcinoma extended within cardia. The clinical management is based on Gastric adenocarcinoma TNM staging.

In the latest 8th edition of the American Joint Committee on Cancer TNM staging system for gastric cancer, pN3 is divided into pN3a and pN3b, and pT1N3b and pT2N3b are classified as stage IIIB. Furthermore, pT3N3b is classified as stage IIIC, pT4bN0 and pT4aN2 downstaged from stage IIIB into stage IIIA and pT4aN3a and pT4bN2 from stage IIIC into stage IIIB 1.

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