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Gastric adenocarcinoma (ultrasound)

Case contributed by Dr Ali Basim
Diagnosis almost certain

Presentation

Epigastric discomfort with early satiety, epigastric pain, retrosternal burning and dyspepsia for two-month duration.

Patient Data

Age: 55 years
Gender: Female
ultrasound

Thickening of the pyloric wall (15 mm wall thickness), loss of gut signature, and multiple enlarged regional lymph nodes, the largest measuring 26 x 14 mm.

Contrast-enhanced CT scan shows circumferential wall thickening of the gastric antrum and pylorus, with narrowing of the lumen and gastric outlet obstruction resulting in a distended stomach containing food residue. Perigastric fat stranding.

Enlarged regional and para-aortic lymph nodes.

Case Discussion

Presented with a 2-month history of epigastric pain and discomfort. Ultrasound demonstrated thickening of the distal stomach. A CT scan of the abdomen showed a thickened stomach wall at the antral and pyloric regions with proximal dilation and regional lymphadenopathy.

The differential diagnosis was that of gastric adenocarcinoma versus gastric lymphoma. The involvement of the distal stomach with gastric outlet obstruction and obliteration of adjacent fat planes pointed toward adenocarcinoma.

The patient underwent gastroscopy with a biopsy taken for histology, which confirmed gastric adenocarcinoma.

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