Pyloric signet cell gastric carcinoma

Case contributed by Dr Michael P Hartung

Presentation

Epigastric pain and early satiety.

Patient Data

Age: 60 years
Gender: Male

Presentation

CT

Mild irregular thickening of the pylorus, somewhat difficult to discern given the adjacent admixture of oral contrast and gastric contents. 

2 months later

CT

More pronounced thickening of the pylorus with mucosal hyperenhancement and irregularity, and submucosal thickening with intermediate attenuation. Gastroesophageal reflux. 

Case Discussion

Both early and later presentations of gastric adenocarcinoma are illustrated in this case. Between the two cases, the patient underwent EGD with biopsy confirming signet cell carcinoma of the pylorus. In the first case while it is challenging to pick up on the subtle thickening of the pylorus due to mixing of oral contrast and gastric contents, it is in retrospect irregular enough to prompt a recommendation for endoscopy in the correct clinical setting. In the follow-up study, there is increasing enhancement and irregularity of the mucosa with pronounced submucosal thickening, likely a combination of infiltrative tumor and inflammation. 

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