Lee D H, Choi B I, Lee M G, Park C M, Park K S, Ko Y T, Lim J H, Auh Y H
Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, Korea.
AJR Am J Roentgenol. 1994 Jul;163(1):77-80. doi: 10.2214/ajr.163.1.8010252.
Exophytic adenocarcinomas of the stomach are tumors that have large extraluminal portions. Exophytic growth of gastric carcinoma is rare, and such tumor may be confused with gastric leiomyosarcoma. The purpose of this study was to assess the CT findings of exophytic adenocarcinoma of the stomach and to determine their value in distinguishing between it and gastric leiomyosarcoma.
Twenty patients with exophytic adenocarcinomas of the stomach confirmed by surgery or endoscopic biopsy were included in the study. CT scans were assessed retrospectively for the size, location, and character of the mass and the presence of adjacent thickening of the gastric wall and outlet obstruction.
The masses were from 5 to 14 cm in diameter (mean, 9 cm). The mass was in the gastric antrum in 11 cases, the body of the stomach in six cases, the body and antrum in two cases, and the gastric fundus and body in one case. CT showed an exogastric mass with a variable degree of internal low density or necrosis in all 20 cases. Thickening of the gastric wall adjacent to the mass appeared to be a specific finding of exogastric adenocarcinoma (n = 14); it was not seen in reported cases of leiomyosarcoma. Gastric outlet obstruction was seen in four cases, and ulcer was detected in eight cases. The degree of low density or necrosis within the mass was minimal in eight cases, moderate in seven cases, and severe in five cases.
Our results suggest that CT findings of thickening of the gastric wall adjacent to an exogastric mass, representing spread of cancer to adjacent gastric wall, and/or gastric outlet obstruction are typical of exophytic adenocarcinoma of the stomach and allow distinction between it and gastric leiomyosarcoma.
胃外生性腺癌是具有较大腔外部分的肿瘤。胃癌的外生性生长罕见，此类肿瘤可能与胃平滑肌肉瘤相混淆。本研究的目的是评估胃外生性腺癌的CT表现，并确定其在鉴别胃外生性腺癌与胃平滑肌肉瘤方面的价值。
本研究纳入了20例经手术或内镜活检确诊为胃外生性腺癌的患者。对CT扫描进行回顾性评估，观察肿块的大小、位置、特征以及胃壁相邻部位增厚和出口梗阻的情况。
肿块直径为5至14厘米（平均9厘米）。肿块位于胃窦部11例，胃体部6例，胃体和胃窦部2例，胃底和胃体部1例。CT显示所有20例均有胃外肿块，内部密度不同程度减低或有坏死。肿块相邻胃壁增厚似乎是胃外生性腺癌的特异性表现（n = 14）；在已报道的平滑肌肉瘤病例中未见此表现。4例出现胃出口梗阻，8例检测到溃疡。肿块内低密度或坏死程度：轻度8例，中度7例，重度5例。
我们的结果表明，胃外肿块相邻胃壁增厚（代表癌向相邻胃壁浸润）和/或胃出口梗阻的CT表现是胃外生性腺癌的典型表现，有助于将其与胃平滑肌肉瘤相鉴别。
