Clinical significance of the deep learning algorithm based on contrast-enhanced CT in the differential diagnosis of gastric gastrointestinal stromal tumors with a diameter ≤ 5 cm / 中华胃肠外科杂志

Objective: Contrast-enhanced CT is an important method of preoperative diagnosis and evaluation for the malignant potential of gastric submucosal tumor (SMT). It has a high diagnostic accuracy rate in differentiating gastric gastrointestinal stromal tumor (GIST) with a diameter greater than 5 cm from gastric benign SMT. This study aimed to use deep learning algorithms to establish a diagnosis model (GISTNet) based on contrast-enhanced CT and evaluate its diagnostic value in distinguishing gastric GIST with a diameter ≤ 5 cm and other gastric SMT before surgery. Methods: A diagnostic test study was carried out. Clinicopathological data of 181 patients undergoing resection with postoperative pathological diagnosis of gastric SMT with a diameter ≤ 5 cm at Department of Gastrointestinal Surgery of Renji Hospital from September 2016 to April 2021 were retrospectively collected. After excluding 13 patients without preoperative CT or with poor CT imaging quality, a total of 168 patients were enrolled in this study, of whom, 107 were GIST while 61 were benign SMT (non-GIST), including 27 leiomyomas, 24 schwannomas, 6 heterotopic pancreas and 4 lipomas. Inclusion criteria were as follows: (1) gastric SMT was diagnosed by contrast-enhanced CT before surgery; (2) preoperative gastroscopic examination and biopsy showed no abnormal cells; (3) complete clinical and pathological data. Exclusion criteria were as follows: (1) patients received anti-tumor therapy before surgery; (2) without preoperative CT or with poor CT imaging quality due to any reason; (3) except GIST, other gastric malignant tumors were pathologically diagnosed after surgery. Based on the hold-out method, 148 patients were randomly selected as the training set and 20 patients as the test set of the GISTNet diagnosis model. After the GISTNet model was established, 5 indicators were used for evaluation in the test set, including sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operating curve (AUC). Then GISTNet diagnosis model was compared with the GIST-risk scoring model based on traditional CT features. Besides, in order to compare the accuracy of the GISTNet diagnosis model and the imaging doctors in the diagnosis of gastric SMT imaging, 3 radiologists with 3, 9 and 19 years of work experience, respectively, blinded to clinical and pathological information, tested and judged the samples. The accuracy rate between the three doctors and the GISTNet model was compared. Results: The GISTNet model yielded an AUC of 0.900 (95% CI: 0.827-0.973) in the test set. When the threshold value was 0.345, the sensitivity specificity, positive and negative predictive values of the GISTNet diagnosis model was 100%, 67%, 75% and 100%, respectively. The accuracy rate of the GISTNet diagnosis model was better than that of the GIST-risk model and the manual readings from two radiologists with 3 years and 9 years of work experience (83% vs. 75%, 60%, 65%), and was close to the manual reading of the radiologist with 19 years of work experience (83% vs. 80%). Conclusion: The deep learning algorithm based on contrast-enhanced CT has favorable and reliable diagnostic accuracy in distinguishing gastric GIST with a diameter ≤ 5 cm and other gastric SMT before operation.

Differentiating gastric cancer and gastric lymphoma using texture analysis (TA) of positron emission tomography (PET) / 中华医学杂志(英文版)

BACKGROUND@#Texture analysis (TA) can quantify intra-tumor heterogeneity using standard medical images. The present study aimed to assess the application of positron emission tomography (PET) TA in the differential diagnosis of gastric cancer and gastric lymphoma.@*METHODS@#The pre-treatment PET images of 79 patients (45 gastric cancer, 34 gastric lymphoma) between January 2013 and February 2018 were retrospectively reviewed. Standard uptake values (SUVs), first-order texture features, and second-order texture features of the grey-level co-occurrence matrix (GLCM) were analyzed. The differences in features among different groups were analyzed by the two-way Mann-Whitney test, and receiver operating characteristic (ROC) analysis was used to estimate the diagnostic efficacy.@*RESULTS@#InertiaGLCM was significantly lower in gastric cancer than that in gastric lymphoma (4975.61 vs. 11,425.30, z = -3.238, P = 0.001), and it was found to be the most discriminating texture feature in differentiating gastric lymphoma and gastric cancer. The area under the curve (AUC) of inertiaGLCM was higher than the AUCs of SUVmax and SUVmean (0.714 vs. 0.649 and 0.666, respectively). SUVmax and SUVmean were significantly lower in low-grade gastric lymphoma than those in high grade gastric lymphoma (3.30 vs. 11.80, 2.40 vs. 7.50, z = -2.792 and -3.007, P = 0.005 and 0.003, respectively). SUVs and first-order grey-level intensity features were not significantly different between low-grade gastric lymphoma and gastric cancer. EntropyGLCM12 was significantly lower in low-grade gastric lymphoma than that in gastric cancer (6.95 vs. 9.14, z = -2.542, P = 0.011) and had an AUC of 0.770 in the ROC analysis of differentiating low-grade gastric lymphoma and gastric cancer.@*CONCLUSIONS@#InertiaGLCM and entropyGLCM were the most discriminating features in differentiating gastric lymphoma from gastric cancer and low-grade gastric lymphoma from gastric cancer, respectively. PET TA can improve the differential diagnosis of gastric neoplasms, especially in tumors with similar degrees of fluorodeoxyglucose uptake.

Catheter-related infection due to Papiliotrema laurentii in an oncologic patient: Case report and systematic review

ABSTRACT Background: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. Aim: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. Methods: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and Opengray.eu. There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. Results: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. Conclusion: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.

Endoscopic full-thickness resection for gastric gastrointestinal stromal tumor originating from the muscularis propria

SUMMARY OBJECTIVE: This study retrospectively reviewed 46 cases of gastric gastrointestinal stromal tumors treated by endoluminal endoscopic full-thickness resection (EFR) microsurgery in our gastrointestinal endoscopy center. We aimed to evaluate the EFR for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria. METHODS: A total of 46 patients with gastric gastrointestinal stromal tumors originated from the muscularis propria layer from January 2012 to June 2015 were treated with EFR. The patients were followed up with gastroscope and computed tomography (CT) for evaluation of therapeutic effect and safety. RESULTS: EFR was successfully accomplished to remove all tumors in 46 patients. The mean procedure time was 82.5±39.8min (56-188min). Except in 3 leiomyomas, pathological examination confirmed gastrointestinal stromal tumor (GIST) in 43 cases. None of the patients had occurred bleeding, peritonitis and other complications after EFR. Thereafter, all patients were followed up with gastro-scope after 1, 6,12 months. CONCLUSIONS: EFR is effective and safe for patients with gastric gastrointestinal stromal tumors originated from muscularis propria layer and has the advantage of less invasive treatment and higher tumor resection rate. It should be considered for further application.

RESUMO OBJETIVO: Este estudo revisou retrospectivamente 46 casos de tumores gástricos estromáticos gastrointestinais tratados por microcirurgia endoluminal endoscópica de ressecção completa (EFR) em nosso centro de endoscopia gastrointestinal. Pretendemos avaliar a EFR para o tratamento de tumores gastrointestinais estromáticos originários da muscularis própria. MÉTODOS: Um total de 46 pacientes com tumores gástricos estromáticos gastrointestinais originários da camada muscular própria, de janeiro de 2012 a junho de 2015, foi tratado com EFR. Os pacientes foram acompanhados com gastroscópio e tomografia computadorizada (TC) para avaliação de efeitos terapêuticos e segurança. RESULTADOS: A EFR foi realizada com sucesso para remover todos os tumores em 46 pacientes. O tempo médio de procedimento foi de 82,5±39,8 min (56-188 min). Exceto em três leiomiomas, exame patológico confirmou tumor estromal gastrointestinal (Gist) em 43 casos. Em nenhum paciente ocorreu sangramento, peritonite e outras complicações após EFR. Posteriormente, todos os pacientes foram acompanhados com gastroscópio após um, seis e 12 meses. CONCLUSÕES: A EFR é eficaz e segura para pacientes com tumores gastrointestinais originários da camada muscular própria e tem a vantagem de ser um tratamento menos invasivo e com maior taxa de ressecção tumoral. Deve ser considerada para posterior aplicação.

Validación de prueba diagnóstica. Valor del ultrasonido hidrogástrico en la detección del cáncer gástrico / Validation of diagnostic test. Value of hydrogastric ultrasound in the detection of gastric cancer

Fundamento: el cáncer gástrico constituye la segunda causa de muerte por cáncer en el mundo. Objetivo: validar el ultrasonido hidrogástrico en el diagnóstico del cáncer gástrico avanzado. Métodos: el ultrasonido hidrogástrico fue realizado por dos observadores independientes a 100 pacientes, 30 con cáncer gástrico avanzado, confirmados por endoscopia y biopsia; y 70 pacientes sin cáncer gástrico. Resultados: por regresión logística se determinó que el engrosamiento de la pared gástrica fue el único signo con valor como predictor de la presencia de CG. La sensibilidad, especificidad, certeza, valor predictivo positivo y valor predictivo negativo del ultrasonido hidrogástrico fueron de 83,3 por ciento; 90, por ciento; 88,0 por ciento; 78,1 por ciento y 92,6 por ciento respectivamente. Conclusiones: el ultrasonido hidrogástrico es una modalidad diagnostica útil en el diagnóstico del cáncer gástrico avanzado(AU)

Background: gastric cancer still remains one of the most common malignancies worldwide. Objective: to validate the Conventional hydrogastric ultrasound in the diagnosis of the advanced gastric cancer. Methods: the hydrogastric ultrasound was carried out by two independent observers 30 with cancer patients with advanced gastric cancer, confirmed by endoscopy and biopsy; and 70 patients without gastric cancer. Results: for logistical regression it was determined that the thickening of the gastric wall was the only sign with value like predictor of the presence of advancedgastric cancer. The sensibility, specificity, certainty, value positive predictive and value negative predictive of the hydrogastric ultrasound in the diagnosis of gastric cancer were of 83,3 percent; 90;0 percent; 88,0 percent; 78,1 percent y 92,6 percent respectively. Conclusions: the Hydrogastric ultrasound is a diagnostic modality useful in the diagnosis of the advanced gastric cancer(AU)

Características endoscópicas y patológicas del cáncer gástrico en un hospital público peruano / Endoscopic and pathological characteristics of gastric cancer in a Peruvian public hospital

RESUMEN Objetivo: Evaluar las características endoscópicas y patológicas del cáncer gástrico del Hospital Nacional Luis N. Sáenz entre 2008 y 2013. Materiales y métodos: Estudio observacional retrospectivo transversal. Se revisó los informes endoscópicos, de pacientes mayores a 30 años, se ingresó al estudio el diagnóstico histológico de adenocarcinoma gástrico, las variables patológicas como tipo histológico, presencia deH. pylori y de metaplasia intestinal e incompleta. Resultados: Se identificó 92 casos de adenocarcinoma gástrico. Prevalencia promedio 0,6%, prevalencia de 0,34% en 2009 y 0,82% en 2013, sexo masculino 62%, femenino 38%, edad menor de 55 años 16%, mayor a 76 años 42%; presentación endoscópica Borrmann III 57%, II 16,3%, IV 15%, V 7,6%, I 3,3%; presentación distal 8 veces más frecuente que la proximal, tipo histológico intestinal 75%, H. pylori presente en 50% casos, metaplasia intestinal en 40% de casos de cáncer gástrico. Conclusiones: Se encontró una alta prevalencia de cáncer gástrico. Frecuente en sexo masculino y en mayores de 76 años, presentación endoscópica más frecuente fue Borrmann III, la presencia de H. pylori y metaplasia intestinal incompleta asociada a cáncer tipo intestinal

ABSTRACT Objective: The endoscopic and pathological characteristics of gastric cancer in Luis N. Sáenz National Hospital between 2008 and 2013. Materials and methods: retrospective cross-sectional observational study. We reviewed the endoscopic reports of patients older than 30 years, we studied the histological diagnosis of gastric adenocarcinoma, pathological variables such as histological type, presence of H. pylori and complete and incomplete intestinal metaplasia. Results: 92 cases of gastric adenocarcinoma were identified. Average prevalence 0.6%, 0.34% in 2009 and 0.82% in 2013; 62% male, 38% female, age less than 55 years 16%, greater than 76 years 42%; endoscopic presentation Borrmann III 57%, II 16.3%, IV 15%, V 7.6%, I 3.3%; 8 times most frequent presentations distal the proximal v, 75% histologic intestinal type, H. pylori in 50% cases, intestinal metaplasia in 40% of cases of gastric cancer. Conclusion: We found high prevalence of gastric cancer. Common in males, and in people over 76, more frequent endoscopic presentation was Borrmann III, the presence of H. pylori and incomplete intestinal metaplasia associated with intestinal cancer type.

Comportamiento del cáncer gástrico avanzado diagnosticado por videoendoscopia en el Hospital "Faustino Pérez Hernandez", Matanzas / Behavior of advanced gastric cancer diagnosed by video-endoscopy at the Faustino Pérez Hernández Hospital, Matanzas

Introducción: el cáncer gástrico avanzado constituye la segunda causa de muerte por tumores malignos en el mundo. En los últimos cinco años en la provincia de Matanzas existe un incremento de esta patología. Objetivo: determinar el comportamiento clínico epidemiológico del cáncer gástrico avanzado diagnosticado por videoendoscopía, en el departamento de Gastroenterología del Hospital Universitario "Comandante Faustino Pérez Hernández", de Matanzas en el período de enero del 2014 a enero del 2016. Materiales y Métodos: se realizó un estudio observacional, descriptivo y prospectivo en el Departamento de Gastroenterología del Hospital Universitario "Comandante Faustino Pérez Hernández", de Matanzas en el período de enero del 2014 a enero del 2016. El universo los 28 pacientes que presentaron cáncer gástrico avanzado por diagnóstico endoscópico e histológico. Resultados: el grupo de edad más afectado correspondió a los pacientes con 60 años de edad o más (67,9 %). El sexo masculino predominó, un 57,1 %. Los factores de riesgo de mayor incidencia fueron la dieta inadecuada (65 %) y el hábito de fumar (42,9 %). Las manifestaciones clínicas más relevantes fueron la pérdida de peso, la astenia y la acidez. La variedad histica que predominó fue el adenocarcinoma de tipo intestinal y el antro gástrico resultó ser la localización más frecuente. La mayoría de los pacientes tuvieron positivos el test de ureasa para la infección por Helicobacter pylori. (60,7 %). Conclusiones: la infección por Helicobacter pylori constituye una de las principales causas de cáncer gástrico. El diagnóstico y tratamiento precoz de la infección contribuirán a disminuir su incidencia (AU).

Introduction: the advanced gastric cancer is the second reason of death due to malignant cancer in the world. There it is a surge of this disease in the last five years in the province of Matanzas. Objective: to determine the clinical-epidemiologic behavior of advanced gastric cancer diagnosed by video-endoscopy in the Department of Gastroenterology of the Teaching Hospital "Comandante Faustino Pérez Hernández", of Matanzas, in the period from January 2014 to January 2016. Materials and Methods: an observational, descriptive and prospective study of the department of Gastroenterology of the Teaching Hospital "Comandante Faustino Pérez Hernández", of Matanzas, was carried in the period from January 2014 to January 2016. The universe were 28 patients who had advanced gastric cancer according to the endoscopic and histological diagnosis. Outcomes: the most affected age group was the one of the patients aged 60 years and more (67,9 %).The male sex predominated, with 57,1 %. The risk factors with higher incidence were an inadequate diet (65 %) and smoking (42,9 %). The most relevant clinical manifestations were weight loss, asthenia and heartburn. The predominating histological variety was the intestinal type adenocarcinoma and the gastric antrum was the most frequent location. Most of the patients were positive to the urease test for helicobacter pylori (60,7 %). Conclusions: the infection by Helicobacter pylori is one of the main causes of gastric cancer. The precocious diagnosis and treatment of the infection will favor the reduction of its incidence (AU).

Tríada de Carney. Una rara asociación de tumores infrecuentes: caso clínico / Carney triad: report of one case

Carney described a disorder characterized by the presence of several uncommon tumors which were pulmonary chondromas, gastric sarcomas and extra-adrenal paragangliomas. We report a 14 year-old girl in whom multiple gastric tumors were discovered during a study of an iron deficiency anemia and was subjected to a partial gastrectomy. At 25 years of age, she developed several pulmonary chondromas and at 33 years, a mediastinal tumor with features of an extra-adrenal paraganglioma was found. At 35 years of age, a total gastrectomy was performed to remove a gastrointestinal stromal tumor with excision of peritoneal and lymph node metastasis. One year later, the patient died due to liver failure secondary to liver metastases.

Endoscopic prediction of tumor invasion depth in early gastric neoplasia: a prospective study in Peru / Predicción endoscópica de invasión tumoral en neoplasia gástrica temprana: Estudio prospectivo en Perú

Introduction: Endoscopic resection is the first option treatment of early gastric cancer with invasion to mucosa or superficial submucosa, because the risk of nodal metastasis is negligible. Then the prediction of tumor invasion is cardinal. Objectives: Determine the accuracy of endoscopic prediction for tumor invasion depth in early gastric neoplasia and define endoscopic characteristics associated with massive submucosal invasion. Materials and methods: Prospective sudy of diagnostic test validation. We included patients with early gastric neoplasias that were endoscopically or surgically resected from January 2012 to May 2016. Every lesion was looked for the presence of these features: margin elevation, central elevation, irregular surface, enlarged folds, size > 30mm and rigidity. The invasion prediction was categorized in: M-Sm1 when none feature was present, Sm2 when 2 or more features were present, and indeterminated when only one feature was present. We compared endoscopic prediction to pathological staging and determined diagnostic accuracy. Results: The global accuracy for endoscopic prediction was 98.2%. Sensitivity, specificity, positive and negative predictive values for M-Sm1 prediction were 97.6, 100, 100 y 92.8%, and for Sm2 prediction were 100, 97.6, 92.8 y 97.6%, respectively. Rigidity, irregular Surface, margin elevation and enlarged folds were associated with Sm2 invasion. Conclusions: Endoscopic prediction of tumor invasion depth in early gastric neoplasia is very accurate. The main endoscopic feature associated with Sm2 invasion is rigidity.

Introducción: La resección endoscópica constituye el tratamiento de elección del cáncer gástrico temprano con invasión a la mucosa o submucosa superficial, pues tiene riesgo casi nulo de metástasis ganglionar. Por tanto, la predicción de invasión tumorales cardinal. Objetivos: Determinar la precisión de la predicción de invasión tumoral de neoplasia gástrica temprana por endoscopía convencional y definir características endoscópicas asociadas a invasión submucosa masiva. Material y métodos: Estudio prospectivo de validación de una prueba diagnóstica. Se incluyeron todos los pacientes con neoplasias gástricas tempranas que fueron resecadas endoscópica o quirúrgicamente de enero 2012 a mayo 2016. En cada lesión se definió la presencia de las siguientes características: Elevación de márgenes, elevación central, irregularidad de la superficie, engrosamiento de pliegues, tamaño >30 mm y rigidez. La predicción de invasión se categorizó en: M-Sm1 cuando no tenía ninguna característica, Sm2 cuando tenía 2 o más características, e indeterminada cuando sólo tenía una característica. Se comparó la predicción endoscópica con el estadiaje patológico de los especímenes y se determinó su precisión diagnóstica. Resultados: La precisión global de la predicción endoscópica fue de 98,2%. La sensibilidad, especificidad, VPP y VPN para la predicción M-Sm1 fue 97,6, 100, 100 y 92,8%, y para la predicción Sm2 fue 100, 97,6, 92,8 y 97,6%, respectivamente. La rigidez, irregularidad en la superficie, elevación de los márgenes y engrosamiento de pliegues, se asociaron significativamente con invasión Sm2. Conclusiones: La predicción endoscópica de invasión tumoral en neoplasia gástrica temprana es muy precisa. La principal característica endoscópica asociada a invasión Sm2 es la rigidez.

Giant gastric lipossarcoma: case report and review of the literature / Lipossarcoma gástrico gigante: relato de caso e revisão da literatura

ABSTRACT Liposarcoma is one of the most common soft tissue sarcomas in adults, occurring in 15 to 20% of all patients with sarcoma. Primary liposarcoma of the stomach is rare. We report a case of patient with giant gastric liposarcoma who underwent surgery after a gastrointestinal bleeding. Preoperative hystopathological diagnosis was not established, even after three biopsy attempts. We discuss differential diagnosis, genetic causes, diagnosis strategies and treatment.

RESUMO O lipossarcoma é um tipo comum de sarcomas em adultos, com incidência entre 15 e 20% entre os sarcomas. No entanto, o acometimento do estômago é raro. Relatamos um caso de um lipossarcoma primário gástrico gigante com apresentação clínica de hemorragia digestiva. Foi submetido a tratamento cirúrgico sem diagnóstico definitivo, apesar de três biópsias realizadas. Revisamos diagnósticos diferenciais, influência genética e estratégias diagnósticas e terapêuticas.

Tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography: association with N categories

OBJECTIVE: To determine whether the gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict the presence of regional lymph node metastasis and could determine N categories. MATERIALS AND METHODS: A total of 202 consecutive patients with gastric adenocarcinoma who had undergone gastrectomy 1 week after contrast-enhanced multidetector computed tomography were retrospectively identified. The gross tumor volume was evaluated on multidetector computed tomography images. Univariate and multivariate analyses were performed to determine whether the gross tumor volume could predict regional lymph node metastasis, and the Mann-Whitney U test was performed to compare the gross tumor volume among N categories. Additionally, a receiver operating characteristic analysis was performed to identify the accuracy of the gross tumor volume in differentiating N categories. RESULTS: The gross tumor volume could predict regional lymph node metastasis (p<0.0001) in the univariate analysis, and the multivariate analyses indicated that the gross tumor volume was an independent risk factor for regional lymph node metastasis (p=0.005, odds ratio=1.364). The Mann-Whitney U test showed that the gross tumor volume could distinguish N0 from the N1-N3 categories, N0-N1 from N2-N3, and N0-N2 from N3 (all p<0.0001). In the T1-T4a categories, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 12.3 cm3), N0-N1 from N2-N3 (cutoff, 16.6 cm3), and N0-N2 from N3 (cutoff, 24.6 cm3). In the T4a category, the gross tumor volume could differentiate N0 from the N1-N3 categories (cutoff, 15.8 cm3), N0-N1 from N2-N3 (cutoff, 17.8 cm3), and N0-N2 from N3 (cutoff, 24 cm3). CONCLUSION: The gross tumor volume of resectable gastric adenocarcinoma on multidetector computed tomography could predict regional lymph node metastasis and N categories.

Efficacy of Positron Emission Tomography/Computed Tomography in Gastric Mucosa-associated Lymphoid Tissue Lymphoma / 대한소화기학회지

BACKGROUND/AIMS: This study evaluated the diagnostic efficacy of fluorine-18 fluorodeoxyglucose PET/CT (F-18 FDG PET/CT) for patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma and examined the association between FDG avidity and the clinical factors affecting lesions. METHODS: Among the patients diagnosed with gastric MALT lymphoma, 16 who underwent a PET/CT for gastric MALT lymphoma were semi-quantitatively and qualitatively tested for FDG avidity of lesions in the stomach. Retrospectively collected data was analyzed to investigate the clinicoradiological factors and endoscopic findings between the patients with positive F-18 FDG PET/CT scans and those with negative scans. RESULTS: Eight of the 16 patients showed FDG avidity. When comparing the size of lesions in the stomach, the patients with FDG avidity had significantly larger lesions than those without (28.8 mm vs. 15.0 mm, p=0.03). The FDG-avid group has a significantly higher rate of positive CT scans than the non-avid group (75% vs. 13%, p=0.03). According to the endoscopic finding of the lesions, FDG avidity was pronounced with 75% of the protruding tumors, and 100% of the erosive-ulcerative types, which are a type of depressed tumors. CONCLUSIONS: When gastric MALT lymphoma is large, when lesions are found using abdominal CT scans, and the macroscopic appearance of a lesion is that of a protruding tumor or erosive-ulcerative type of depressed tumor, there is a high probability that such patients may have a positive F-18 FDG PET/CT scan.

Linitis plástica gástrica. A propósito de un caso / Gastric-plastic letinitis. A case report

Fundamento: el cáncer gástrico es una de las principales causas de muerte. En Cuba la mayoría son diagnosticados en fases avanzadas ensombreciendo el pronóstico. La linitis plástica es una forma de crecimiento submucoso del adenocarcinoma. Objetivo: ofrecer lección a médicos sobre los signos endoscópicos de sospecha y complementarios a utilizar para diagnosticarlo rápidamente. Presentación de caso: paciente que refería epigastralgia, vómitos y pérdida de peso. La radiografía contrastada de estómago evidenció rigidez y defecto de lleno en curvatura mayor y menor. La esofagogastroduodenoscopía mostró ausencia de peristalsis y estenosis de la luz del estómago. En el examen laparoscópico se observó exteriorización del tumor. El diagnóstico definitivo se realizó por macrobiopsia después de la cirugía. Conclusiones: se ha de sospechar la entidad ante un paciente con la clínica sugestiva de tumor y hallazgos endoscópicos como la disminución de la peristalsis y la reducción de la luz del órgano.

Background: gastric cancer is one of the main causes of death. In Cuba most of the cases are diagnosed in advanced stages clouding the outlook. The plastic linitis is a form of submucosal growth adenocarcinoma. Objective: to provide medical lesson on endoscopic signs of suspicion and complementary use to diagnose it quickly. Case Presentation: a patient referred epigastralgia, vomiting and weight loss. The stomach contrasted radiography showed stiffness and squarely defect in major and minor curvature. The esophagogastroduodenoscopy showed absence of peristalsis and stenosis of the light of the stomach. In the laparoscopic exam the tumor externalization was observed. The final diagnosis was carried out by macrobiopsy after surgery. Conclusions: doctors have to suspect the disease in a patient with clinical suggestive features of tumor and endoscopic findings as decreased peristalsis and reduced organ light.

Gastric cancer staging comparism and role of EUS

The tumor stage of gastric cancer in the preoperative period must be evaluated to choose the type of therapy so the preoperative imaging diagnosis is the basis for a tumor-stage -adapted therapy of each patient. Is to compare between the preoperative staging of gastric cancer which includes the ultrasound scan, CT scan and EUS findings and the postoperative staging which include the histopathological finding and to assess the efficacy of EUS in determining the tumor and lymph node stage of tumor. Prospective study of 32 patients with gastric cancer admitted to the surgical word in the gastroenterology and hepatology teaching hospital, medical city, Baghdad over the period from Nov. 2005 to Nov. 2007 who underwent gastric resection, all the cases were proved to be gastric cancer by endoscopic biopsy or by histopathological examination of the gastric specimen after operative resection, and all the cases radiologically investigated in the preoperative period by abdominal ultrasound, endoluminal ultrasound and abdominal CT scan. Show that there is increase in the staging in 18 [56.25%] cases and same staging in 8 [25%] cases and decrease staging in 6 [18.75%] cases. Endoluminal ultrasound is most accurate preoperative investigation to determine staging of gastric malignancy. Ultrasound and CT scan although it is important in the assessment but they downstage the tumor in about half of cases. So we recommend that EUS is done for all patients with gastric cancer for accurate planning for surgery

Epstein-Barr Virus-Associated Lymphoepithelioma-Like Gastric Carcinoma Presenting as a Submucosal Mass: CT Findings with Pathologic Correlation

A lymphoepithelioma-like carcinoma, characterized by a carcinoma with heavy lymphocyte infiltration, is one of the histological patterns observed in patients with Epstein-Barr virus (EBV)-associated gastric carcinoma. Less than half of invasive carcinomas with lymphoepithelioma-like histology can grow to make a submucosal mass. These tumors generally have a better prognosis than conventional adenocarcinomas. We report a case of an EBV-associated lymphoepithelioma-like gastric carcinoma that presented as a submucosal mass on multi-detector (MD) CT and correlate them with the pathology.

Metastatic Gastric Linitis Plastica from Bladder Cancer Mimicking a Primary Gastric Carcinoma: a Case Report

Primary gastric carcinoma is the most common cause of linitis plastica. Less frequently, metastatic gastric cancer from the breast, omental metastases and non-Hodgkin lymphoma involving the stomach have been reported to show similar radiographic findings as for linitis plastica. A metastatic gastric cancer from bladder cancer is extremely rare. We present an unusual case, the first to our knowledge, of gastric linitis plastica that resulted from a metastatic urothelial carcinoma of the bladder.

Positioning During CT Gastrography in Patients with Gastric Cancer: the Effect on Gastric Distension and Lesion Conspicuity

OBJECTIVE: We wanted to prospectively evaluate the effect of various positions of the patient on gastric distension and lesion conspicuity during performance of CT gastrography (CTG). MATERIALS AND METHODS: One hundred thirteen consecutive patients with gastric cancer underwent CTG in the 30degrees left posterior oblique (LPO), supine, and prone positions. Two radiologists scored (a grade from 1-4) the degree of gastric distension and the lesion conspicuity according to the three scanning positions and the three gastric portions. Two- (2D) and three-dimensional (3D) images were used for analysis. Finally, these data were compared with the endoscopic findings and surgical results. RESULTS: The mean scores of gastric distension and lesion conspicuity for the LPO and supine positions were higher than those for the prone position (p or = 0.21). As for the gastric upper portion, the mean scores of gastric distension in the prone position were higher than those in the two other positions (p < 0.001). The prone position showed better lesion conspicuity than the two other positions for only one of two cases of gastric cancer in the upper portion of the stomach. CONCLUSION: CTG performed in the LPO position or the supine position combined with CTG performed in the prone position is optimal for achieving good gastric distension and evaluating the lesion conspicuity of gastric cancer.