2. HISTORY
A 50 year old woman presented with
• Pain in the abdomen, especially over the LEFT flank and lumbar
region, a feeling of mass in the abdomen, and weight loss for 3
months, with gradual increase in pain and loss of appetite since two
months.
• Clinical examination revealed two palpable masses in the abdomen
over the epigastric and left lumber region.
• H/o hysterectomy present
• Blood investigations are within normal limits.
246. Approach to characterizing gastric mass
• Location,
• Tumor margin
• Attenuation,
• Enhancement, and
• Pattern of growth,
247.
248. • POLYPOID GROWTH PATTERN suggests a D/D of carcinoid tumor, IFP,
GIST, adenomatous polyp, or polypoid cancer.
• EXOPHYTIC GROWTH patterns include GIST, schwannoma, lymphoma,
or poorly differentiated adenocarcinoma.
• SIZE is also a consideration, and leiomyomas, glomus tumors, IFPs,
and ectopic pancreas are usually less than 5 cm.
• MULTIPLE LESIONS should raise the possibility of carcinoid tumors,
multiple polyps, or metastases.
249. Metastasis
• Common tumors that metastasize to stomach include breast, malignant melanoma,
lung, lymphoma and Kaposi sarcoma.
• Present as multiple small submucosal masses having central ulceration give rise to
“ Target or Bulls eye” appearance.
CYSTIC METASTASIS in liver is commonly seen in
• Colon carcinoma
• Cystadenocarcinoma ovary
• Cystadenocarcinoma pancrease(mucinous)
• Carcinoma lung ( squamous cell)
• GIST
250. GASTRIC ADENOCARCINOMA
Points in favour Points against
• Age group
• Liver metastasis
• Presence of deposit
• Presence of heteregeneously
enhancing exophytic soft tissue
• Absence of gastric outlet obstruction
• Absence of calcification
• Absence of loco-regional
lymphadenopathy
251. GIST
Points in favour
• Age
• Well defined heterogeneous soft tissue
lesion.
• No lymphadenopathy
• No calcification
• No ascites
• No perileisonal fat stranding or
desmoplastic reaction.
Points against
• None
254. Q1.Desmoplastic reaction is most commonly seen in
A) Gastrointestinal adenocarcinoma
B) Carcinoid tumor
C) Gastrointestinal stromal tumors
D) GIT schwwannoma
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th ed,(2017),volume 2
chapter 50,page 1638
255. Ans 1) B
Q2.Gastric outlet obstruction is a feature of which of the following tumor ?
A) GIST
B) Gastric adenocarcinoma
C) Gastrointestinal lymphoma
D) All of the above
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th
ed,(2017),volume 2 chapter 50,page 1638
256. Ans 2)B
Q 3. Most common site of GIST is?
A) Duodenum
B) Stomach
C) Ileum
D) Jejunum
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th ed,(2017),volume 2
chapter 50,page 1637
257. Ans 3) B
Q 4. CT features NOT favoring malignant GIST include?
A) tumor size larger than 5 cm
B) ulceration
C) distant metastases
D) locoregional lymphadenopathy.
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th ed,(2017),volume 2
chapter 50,page 1639
258. Ans 4) D
Q5. Axial CECT scan shows a duodenal mass with intraluminal and exophytic
components along with hypervascular metastasis.
A) Carcinoid
B) GIST
C) Adenocarcinoma
D) Lymphoma
260. Ans 5)A
Q 6. The drug of choice in GIST is?
A)daunorubicin
B)Methotrexate
C)doxorubicin
D)Imanitib
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th ed,(2017),volume 2
chapter 50,page 1639
261. Q 7. 55 years female patient
presented with C/O Vague
abd pain in RUQ - since 4
months
A. Lymphoma
B. GIST
C. Gastric adenocarcinoma
D. Carcinoid
Ans 6) D
262. Ans 7) B
Q 8. Which one is not seen in association with GIST?
A) Carney triad
B) Neurofibromatosis
C) Melanoma
D) All
Reference :John.R.Haaga, CT AND MRI OF THE WHOLE BODY, 6th ed,(2017),volume 2
chapter 50,page 1637
263. Ans8) C
Q9. 35-year-old woman with a history of abdominal discomfort for
several years. On CT exophytic mass lesion with relative homogeneity
and no internal necrotic areas . Likely diagnosis is
A) Gastric schwannomas
B) GIST
C) Carcinoid
D) Adenocarcinoma
264. Ans 9) A
Q 10) 60 yr female present with circumferential
wall thickening of stomach, with abdominal
lymphadenopathy
A. Lymphoma
B. GIST
C. Gastric adenocarcinoma
D. Carcinoid
Dedicated Multidetector CT of the Stomach: Spectrum of Diseases,
RadioGraphics 2003 23:3, 625-644
Inflammatory Myofibroblastic Tumor- agresive intramural mass which can invade gastric wal
Inflammatory Fibroid Polyp
Lymphoma GPL Preservation of perigastric fat plane
Bulky LN below renal hila
GOO uncommon
Inflamatory fibroid polyp
Carcinoid
Axial and coronal cect a well defined endophytic,polypoidal mass lesion seen arising from fundus of stomach, showing progressive enhancement in Arterial ,portal and venous phase.There is no evidence of calcification,hage,no fat stranding.no abdominal LAP.
Triad- extra adrenal paraganglioma, pulmonary chondroma, GIST
cystic degeneration is a common feature of schwannomas found in other parts of the body, this characteristic is uncommon for gastric schwannomas
