Adenocarcinoma of Stomach

Dr. Dur-e-Zarnab Zahra(TR)

SU1
 HISTORY
• 56 years Male
• Farmer
• Smoker for last 30 years
• No comorbidities
• Resident of Lahore
 PRESENTING COMPLAINT
• Severe abdominal pain for 3 months
• Hematemesis (3 episodes in 1 month)
• Weight loss (2-4 kg)
 EXAMINATION
• Pale and anemic
• Soft and non tender abdomen with no mass or
organomegaly , hernial orifices were intact
• ASA : 1
• ECOG : 0
• BMI : 18.5
 HEMATOLOGY AND BIOCHEMISTRY
(31/01/23)
• Hb : 7.9
• WBC : 13.9
• PLT : 450
• Creatinine : 0.82
 ULTRASOUND ABDOMEN
(17/11/22)
• Targeted scan reveals circumferential
thickening ( chronic inflammation) of mid and
lower gastric portion especially pyloric area.

• Impression: Chronic gastritis causing luminal

narrowing
 EGD (27/11/22)
• Esophagus has normal mucosa in upper ,
middle and lower third segments
• Stomach has large ulcerated growth with
raised margins causing deformation of
stomach. Tumor is extending from mid body
along lesser curvature causing luminal
narrowing of pyloric canal. Scope passed with
little resistance across pyloric end and biopsy
taken. D1 And D2 are normal.
 BIOPSY (12/01/23)
• Biopsy reveals moderately differentiated
adenocarcinoma. ( Tumor cells are columnar
and having hyper chromatic nuclei with
occasional cytoplasmic mucinous vacules).
 CT CONTRAST ABDOMEN AND PELVIS
(01/02/23)
• Non circumferential wall thickening in distal
gastric body and antrum along lesser
curvature. Length of thick segment is
approximatley 5 cm. Individual wall thickness
is 16mm. Mild perigastric fat strandings are
present plus there are sub centimeter regional
lymph nodes.
 ECHO (07/02/23)
• EF : 40 %
• Moderate LV systolic function
• Mild calcification of aortic and mitral annulus
 DISUCSSION

Neo adjuvant vs Upfront Resection