Author/Authors :
Lee Jongmee نويسنده Department of Radiology, Korea University Guro Hospital,
Korea University College of Medicine, Seoul, South
Korea , Kim Kyeong A نويسنده Department of Radiology, Korea University Guro Hospital,
Seoul, Korea , Shin Park Yang نويسنده Department of Radiology, Korea University Guro Hospital,
Seoul, Korea , Woong Choi Jae نويسنده Department of Radiology, Korea University Guro Hospital,
Seoul, Korea , Hee Lee Chang نويسنده Department of Radiology, Korea University Guro Hospital,
Seoul, Korea , Min Park Cheol نويسنده Department of Radiology, Korea University Guro Hospital,
Seoul, Korea
Abstract :
Background Neuroendocrine carcinomas (NECs) of the stomach are
poorly differentiated, high-grade endocrine tumors, including small cell
and large cell carcinomas. They are deeply invasive and metastatic, with
a poor prognosis. The purpose of this study is to describe the computed
tomography (CT) findings of gastric NECs with pathologic features.
Patients and Methods CT examinations of 32 patients with gastric NECs
from January 2004 to January 2015 were reviewed retrospectively for
tumor morphology, size, and CT attenuation. CT attenuation of the lymph
nodes, peritumoral infiltration, and associated findings, such as liver
metastasis and peritoneal carcinomatosis were also reviewed. The ages of
patients ranged from 45 to 79 years (mean: 62 years). Twenty-seven
patients (84%) were men. Pathologic diagnosis was made using gastrectomy
(n = 28) and endoscopic biopsy (n = 4). Nineteen patients underwent
multidetector CT with water as an oral contrast agent, and 13 patients
underwent helical CT with water. Results Among the three CT morphologic
types of gastric NEC (polypoid, ulcerofungating, and
ulceroinfiltrative), 63% of those in our study were ulcerofungating (n =
20), 37% were ulceroinfiltrative, and none were polypoid. All were
larger than 5 cm in the greatest diameter (mean size: 7.8 cm). The
characteristic features at presentation were focal (n = 3) or diffuse (n
= 15) low attenuation within the mass, extensive low attenuation
lymphadenopathy (n = 13), and liver metastasis (n = 6). There were no
significant differences between the small cell (n = 10) and the large
cell NEC groups (n = 22). Conclusion Although differential diagnosis
between gastric adenocarcinoma and gastric NEC is difficult, gastric NEC
should be considered when CT shows a large ulcerofungating tumor with
low attenuation areas (pathologically mucinous or necrotic), especially
combined with extensive necrotic lymphadenopathy and frequent hepatic
metastases.
