Presentation
Presented with bloating sensation, early satiety and dyspepsia.
Patient Data
Focal thickening of gastric wall noted, showing moderate inhomogeneous enhancement on post contrast study. No obvious breach in serosa noted. Fat planes with adjacent structures maintained.
Four well defined hypodense lesions with central decreased attenuation noted in abdomen. Post contrast study shows moderate enhancement in arterial phase with central non-enhancing areas. Two of these lesions are seen abutting the lesser curvature of stomach on left side and inferior surface of liver superiorly and on right side. These lesions are seen to be supplied by right gastric artery. The other two lesions are noted along the inferior greater curvature of stomach, one of which shows speck of calcifications. These lesions are seen to be supplied by gastro-duodenal artery.
Consider diagnosis of gastric neuroendocrine tumor with omental deposits.
Case Discussion
Ultrasound guided biopsy of the right hypochondrial mass was performed, where the possibility of neuroendocrine tumor was considered.
Immnunohistochemistry report was positive for Pan CK, Synaptophysin and chromogranin, which confirmed the diagnosis of neuroendocrine tumor.
She underwent laparotomy and total gastrectomy with an uneventful postoperative recovery.
Neuroendocrine tumors with omental deposits is quite uncommon. This can occur via transmesothelial or translymphatic route, though these tumors are more prone to produce hematogenous metastasis.