Hommel C, Knoedler M, Bojarski C, Schumann M, Epple H J, Zeitz M, Daum S
Université Catholique de Louvain, Bruxelles, Belgium.
Case Rep Gastroenterol. 2012 Sep;6(3):695-703. doi: 10.1159/000345385. Epub 2012 Nov 7.
In some cases the diagnosis of gastric cancer is difficult and the endoscopic presentation may be misleading. Diffuse type gastric carcinoma with peritoneal metastasis may present primarily with abdominal pain, colonic infiltration and/or diarrhea, thus other differential diagnoses like Crohn's disease (CD) may be considered at first. Therefore intensive diagnostic work-up is important. We report two cases of gastric cancer with ascites due to peritoneal carcinomatosis who were first diagnosed as CD. The patients were hospitalized in different institutions for weight loss, abdominal pain and nausea. The first colonoscopy, upper endoscopy with multiple biopsies and ascites puncture were negative for malignant disease, but macroscopic lesions resembling CD were described. Both patients were released on a prednisolone-based treatment for suspected CD. They presented to our hospital for further evaluation due to persistent symptoms. Neither lower nor upper endoscopy were suggestive of CD and endoscopic ultrasound was suspicious of malignancy in one case. Histology was diagnostic and showed gastric infiltration by a poorly differentiated adenocarcinoma. Diffuse type gastric cancer (gastric linitis plastica) with peritoneal metastasis may mimic certain clinical, endoscopic and CT imaging features of CD. Repeated biopsies and endoscopic investigations are often necessary to confirm a malignant process, especially in case of an inconclusive clinical and endoscopic picture. Endoscopic ultrasound may be useful to evaluate the risk of malignancy in patients with macroscopic suspicion of malignancy and negative biopsies.
在某些情况下，胃癌的诊断较为困难，内镜表现可能会产生误导。伴有腹膜转移的弥漫型胃癌可能主要表现为腹痛、结肠浸润和/或腹泻，因此最初可能会考虑其他鉴别诊断，如克罗恩病（CD）。所以，深入的诊断检查很重要。我们报告两例因腹膜癌病导致腹水的胃癌患者，他们最初被诊断为CD。这两名患者因体重减轻、腹痛和恶心在不同机构住院。首次结肠镜检查、多次活检的上消化道内镜检查以及腹水穿刺均未发现恶性疾病，但描述有类似CD的宏观病变。两名患者均因疑似CD接受基于泼尼松龙的治疗后出院。由于症状持续，他们到我院进一步评估。上下消化道内镜检查均未提示CD，其中一例内镜超声检查怀疑为恶性肿瘤。组织学检查确诊为低分化腺癌浸润胃。伴有腹膜转移的弥漫型胃癌（皮革胃）可能会模仿CD的某些临床、内镜和CT影像学特征。反复活检和内镜检查对于确诊恶性病变通常是必要的，尤其是在临床和内镜表现不明确的情况下。内镜超声对于评估宏观上怀疑为恶性肿瘤但活检阴性的患者的恶性风险可能有用。
