Stomach 3/2012

Front 1

Gastric Lymphoma

Back 1

1. Most frequent GI site of malignant lymphoma (50% of all GI lymphomas)
2. 1-5% of gastric malignancies
3. Most are Non-Hodgkin
- Gastric Hodgkin disease accounts for 9% of all gastric lymphomas
- Primary gastric Hodgkin disease is extremely rare

Front 2

Gastric Lymphoma: CT Findings
Radiographic appearance often reflects the gross pathologic findings

Back 2

1. Infiltrating form
- Wall thickening(with little enhancement)
- average 4-5 cm ( now picking up earlier)
- diffuse or segmental
- May be difficult to differentiate from scirrhous carcinoma
2. Polypoid mass
3. Adenopathy

Front 3

CT Findings
Lymphoma vs Adenocarcinoma

Back 3

1. CT findings can overlap
2. Lymphoma
- Adenopathy can extend below the renal hilum without perigastric adenopathy
- Can extend into duodenum
- Nodes usually larger in lymphoma
- Perigastric fat plane more likely to be preserved.

Front 4

Gastric Carcinoid

Back 4

- Originate from Kulchitsky cells in the crypts of Lieberkuhn
- Cytoplasm contains eosinophilic granules that have an affinity for solver stain (argenaffinomas)
- < 35% of GI carcinoids are located in stomach
- Most are in distal antrum

Front 5

Gastric Carcinoid

Back 5

Presentation
- Asymptomatic
- Abdominal pain
- Nausea, vomiting
- Weight loss
- Bleeding

Front 6

Gastric Carcinoid

Back 6

1. Rare but recognized complication of prolonged severe hypergastrinemia
- chronic atrophic gastritis
- gastrinoma
- ? H2 blockers
2. Elevated gastrin levels can result in hyperplasia of ECL cells or carcinoid

Front 7

Gastric Carcinoid

Back 7

CT Findings
- Submucosal mass or masses
- Usually 1-4 cm
- Can mimic gastric polyps
- May have associated gastric fold thickening due to elevated gastrin levels.

Front 8

Gastric Carcinoid

Back 8

1. Low grade malignancies
2. Can metastasize
3. Treatment
- Treatment of hypergastrinemia
- Endoscopic excision
- Surgical resection
- Endoscopic surveillance