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Dr/ ABD ALLAH NAZEER. MD.
Radiological imaging of gastric pathology.
Normal gross anatomy.Normal volume is 1.5 liters, capacity is 3 liters, potentially more.● Fine mosaic-like pattern of mucosa because of punctuations by gastric pits or foveolae.● Longitudinal infoldings of mucosa and submucosa known as rugae are coarser proximally and when stomach is empty.Cardia: Narrow conical portion distal to gstroesophageal junction● Many authors claim that cardiac mucosa is reflux-associated epithelia and not normally present● Of note in the AJCC Cancer Staging Manual, 7th Edition (2010), carcinomas of the esophagus and esophagogastric junction (the proximal 5 cm of the stomach) are staged identicallyFundus: ● Dome shaped proximal stomachBody/corpus: ● Remainder of stomach to incisura angularisIncisura angularis: Where stomach narrows before it joins duodenumAntrum: Incisura angularis to pyloric sphincter (3-4 cm)Pylorus: Muscular ring that controls flow of food content into proximal duodenumLesser curvature: Medial curvature of stomach on the rightGreater curvature: Lateral curvature of stomach.
Non-neoplastic anomalies: achalasia of cardia arteriovenous malformation diaphragmatic hernia gastric dilation gastric gland heterotopia heterotopic pancreas/pancreatic metaplasia mucolipidosis pyloric stenosis Gastritis: features to report acute allergic autoimmune carditis Crohn’s disease chronic chronic atrophic collagenous erosive granulomatous graft versus host disease ischemic lymphocytic malakoplakia pseudomembranous reactive (chemical) gastropathy suppurative ulcerative colitis Infections: anthrax Candida CMV Cryptosporidium EBV giardia Helicobacter heilmannii Helicobacter pylori herpes simplex histoplasmosis measles mycobacterium avium-intracellulare syphilis toxoplasmosis tuberculosis Ulcers: peptic ulcer disease acute gastric ulcer chronic peptic ulcer Other non-neoplastic lesions: amyloid aneurysms antral vascular ectasia bezoars calcinosis chloral hydrate colchicine toxicity cyanide cysts diverticula duplication iron kayexelate proton pump inhibitors xanthoma Polyps: adenoma Cowden’s Cronkhite-Canada familial colonic polyposis foveolar hyperplasia fundic gland gastritis cystica polyposa hyperplastic inflammatory fibroid juvenile mixed Peutz-Jeghers Hypertrophic gastropathy: enlarged mucosal folds hypertrophic hypersecretory gastropathy Menetrier’s disease Zollinger-Ellison syndrome
Diseases of the stomach.
Dysplastia: dysplasia Neuroendocrine tumors: classification NET G1/carcinoid large cell neuroendocrine small cell Carcinoma: general WHO classification intestinal diffuse intramucosal GE junction adenosquamous amphicrine hepatoid lymphoepithelioma-like oncocytic Paneth cell rhabdoid sarcomatoid squamous cell Lymphoma: general lymphoid hyperplasia anaplastic large cell diffuse large B cell Hodgkin’s MALT mantle cell T cell Stromal / other tumors: adenosarcoma alveolar soft parts sarcoma choriocarcinoma elastofibroma follicular dendritic cell sarcoma GANT GIST glomus granular cell Langerhans’ cell histiocytosis leiomyoma lipoma malignant fibrous histiocytoma metastases to stomach schwannoma synovial sarcoma teratoma Miscellaneous: staging-general staging-GIST staging-neuroendocrine grossing specimens features to report histologic treatment effect
Non-neoplastic anomalies: achalasia of cardia arteriovenous malformation diaphragmatic hernia gastric dilation gastric gland heterotopia heterotopic pancreas/pancreatic metaplasia mucolipidosis pyloric stenosis
Congenital anomalies of the stomach
Radiographic featuresChildren with hypertrophic pyloric stenosis may show gastric distension prominent, peristaltic waves (caterpillar sign), and mottled retained gastric content.A upper gastrointestinal series (barium meal) excludes other, more serious causes of pathology, but the findings of a UGI series infer rather than directly visualize the hypertrophied muscle.Plain film (abdominal radiograph): Non specific and may show a distended stomach with minimal distal intestinal bowel gas.
Ultrasound: Ultrasound is usually the primary imaging modality 3, and its advantages over a barium meal are that it directly visualizes the pyloric muscle and does not use ionizing radiation. Unfortunately it is incapable of excluding other diagnoses such as midgut volvu lus.The hypertrophied muscle is hypoechoic, and the central mucosa is hyperechoic. There are measurement criteria that vary slightly from source to source. In a normal situation, the pyloric muscle thickness (diame ter of a single muscular wall on a transverse image) should normally be less than 3 mm (most accurate 3) and the length (longitudinal measurement) should not exceed 15 mm.With the patient right side down the pylorus should be watched and should not be seen to open.Described sonographic signs include: antral nipple sign, cervix sign, target sign
Barium meals demonstrate delayed gastric emptying. When some contrast does pass into the duodenum, the pylorus appears elongated with a narrow lumen (string sign) which may appear duplicated due to puckering of the mucosa (double-track sign). The pylorus indents the contrast-filled antrum (shoulder sign) or base of the duodenal bulb (mushroom sign). Additionally the entrance to the pylorus may be beak-shaped (beak sign). Described barium signs include:shoulder signstring signdouble-track signmushroom signbeak sign
Hypertrophic pyloric stenosis.
Morgagni hernia.
Two cases diaphragmatic hernia.
Achalasia of the cardia.
Hypertrophic gastritis with thick gastric folds.
Erosive gastritis.
Atrophic gastritis in patient with known gastric atrophy related to pernicious anemia
Gastritis in 25-year-old woman.
Hypertrophic gastritis.
Gastric ulcer with bull's eye sign.
Barium meal demonstrates a giant gastric ulcer in profile.
Perforated gastric ulcer.
Gastric tuberculosis.
Gastric anisakiasis.
EpithelialPolyps, Papillomata, Adenomata, Polyposis.Mesenchymal.Leiomyomata, Neurofibromata, Fibromata, Lipomata, Osteomata, Osteochondromata, Myomata .EndothelialHemangiomata, Lymphadenomata, Endotheliomata .CystsSimple, Dermoid, Echinococcus .
Benign tumour of the stomach.
Double-contrast barium meal. Large polyp (arrows) arising from the gastric fundus.
Hyperplastic gastric polyps.
Ulcerating leiomyoma of stomach.
Gastric lipoma at the pyloric canal.
Hydatid cyst perforation into the gastric antrum
Malignant tumour of the stomach.
Early gastric cancers. Carcinoma stomach from lesser curvature.
Raised image with irregular stenosis and rigidity of the greater curvature of stomach, gastric antrum to prepyloric level : intestinal type gastric adenocarcinoma.
Gastric carcinoma located on the antro-pyloric tract.
Gastric adenocarcinoma: axial contrast-enhanced CT (CECT) showing tumour arising from the lesser curvature of the stomach (asterisk) associated with enlarged regional gastrohepatic nodes
Advanced gastric carcinoma.
Exophytic adenocarcinoma.
Signet ring cell carcinoma.
Mucinous adenocarcinoma.
Gastro-intestinal stromal tumour(GIST).
GIST arising from the posterior wall of the gastric fundus.
High-grade GISTLow -grade GIST
Enhanced CT scan of GIST.
High grade gastrointestinal stromal tumor.
Gastric lymphoma.
Two cases of gastric lymphoma.
Carcinoid tumours of the stomach.
Carcinoid tumor.
Angiosarcoma of the stomach.
Carcinosarcoma of the stomach.
Direct gastric metastasis of primary pancreatic cancer.
Hematogenous metastasis of neuroendocrine carcinoma to stomach.
Thank You.
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