Presentation
Patient has presented with long standing epigastric pain and dyspepsia.
Patient Data
There is marked, irregular thickening (up to 50.0 mm maximum thickness) of the gastric wall which is involving fundus, cardia, body along the lesser curvature and pyloric canal and extending superiorly in to the esophago-gastric junction. Significant surrounding fat stranding is appreciated.
Multiple enlarged lymph nodes are noted in the peri-gastric, peri-pancreatic, para-aortic regions and in porta-hepatis (largest one of about 29.0 mm in short axis).
Portal vein is dilated and shows persistent filling defect in its main branch (with extension into the right and left branches and distal part of the superior mesenteric vein) suggestive of thrombus formation.
The liver is enlarged in size with heterogeneous density and shows few, variable in size and shape (predominantly hypodense with no definite density changes on provided images) lesions with largest one of about 4.5 x 5.6 cm in segment 5. The hepatic veins are patent. The intrahepatic and extrahepatic bile ducts are unremarkable.
Mild amount of free fluid is seen in abdomino-pelvic cavity.
Prostate is mildly enlarged in size.
Slices through chest (not shown) were within normal limits.
Case Discussion
Pathology:
Poorly differentiated carcinoma, suggestive of adenocarcinoma.
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Findings are of gastric wall malignant mass lesion with regional lymphadenopathy and most likely hepatic metastasis (cT3N3M1) along with portal vein thrombus formation, prostatomegaly and ascites as described above.
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