Digestive and Liver Disease 47 (2015) 174
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Magnetic resonance imaging diffusion-weighted imaging for diagnosis of a gastric hepatoid adenocarcinoma Guillaume Velut a , Florence Mary a , Vanessa Aflalo b , Thomas Aparicio a,∗ a b
Gastroenterology, Avicenne Hospital, HUPSSD, APHP, University Paris 13, Sorbonne Paris Cité, Bobigny, France Radiology, Avicenne Hospital, HUPSSD, APHP, Bobigny, France
A 63-year-old man consulted his general practitioner (GP) for abdominal pain in March 2010. Laboratory examination revealed an elevated alpha-fetoprotein and the GP referred the patient for suspected hepatocellular carcinoma. A computed tomography scan showed no tumour. Magnetic resonance imaging (MRI) confirmed the absence of hepatic tumour but showed irregular thickening of stomach wall on T2-weighted image with an increased signal on high b-value (1000 s/mm2 ) in diffusion-weighted imaging (Fig. 1). Upper endoscopy revealed a large ulcerated tumour of the distal stomach. Biopsy samples revealed hepatoid adenocarcinoma (HAC) and the patient underwent subtotal gastrectomy. The tumour was a
Fig. 2.
Fig. 1.
moderately differentiated adenocarcinoma composed of hepatoid cells nests surrounded by fibrovascular stroma (Fig. 2, staining with haematoxylin and eosin), pT2N1M0. The patient was treated by adjuvant chemotherapy (FOLFOX) and no recurrence was observed (last follow-up, April 2014). MRI diffusion-weighted imaging is a new modulation of MRI that can be used to assess abdominal staging of digestive tumours [1]. In this case, the MRI diffusion-weighted imaging was performed for a suspected hepatocellular carcinoma, allowing the fortuitous diagnosis of a gastric carcinoma. This is the first report of MRI diffusion-weighted imaging of HAC, a rare alpha fetoproteinproducing carcinoma arising in extra-hepatic organs. All diseases which exhibit inflammation or hypercellularity may have an increased MRI-diffusion signal. Reference
∗ Corresponding author at: Gastroenterology and Digestive Oncology, Avicenne Hospital, APHP, Paris 13 University, 125 rue de Stalingrad, 93000 Bobigny, France. Tel.: +33 1 48 95 54 31; fax: +33 1 48 95 54 39. E-mail address: [email protected] (T. Aparicio).
[1] Soussan M, Des Guetz G, Barrau V, et al. Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy. European Radiology 2012;22:1479–87.
http://dx.doi.org/10.1016/j.dld.2014.08.044 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Magnetic resonance imaging diffusion-weighted imaging for diagnosis of a gastric hepatoid adenocarcinoma Guillaume Velut a , Florence Mary a , Vanessa Aflalo b , Thomas Aparicio a,∗ a b
Gastroenterology, Avicenne Hospital, HUPSSD, APHP, University Paris 13, Sorbonne Paris Cité, Bobigny, France Radiology, Avicenne Hospital, HUPSSD, APHP, Bobigny, France
A 63-year-old man consulted his general practitioner (GP) for abdominal pain in March 2010. Laboratory examination revealed an elevated alpha-fetoprotein and the GP referred the patient for suspected hepatocellular carcinoma. A computed tomography scan showed no tumour. Magnetic resonance imaging (MRI) confirmed the absence of hepatic tumour but showed irregular thickening of stomach wall on T2-weighted image with an increased signal on high b-value (1000 s/mm2 ) in diffusion-weighted imaging (Fig. 1). Upper endoscopy revealed a large ulcerated tumour of the distal stomach. Biopsy samples revealed hepatoid adenocarcinoma (HAC) and the patient underwent subtotal gastrectomy. The tumour was a
Fig. 2.
Fig. 1.
moderately differentiated adenocarcinoma composed of hepatoid cells nests surrounded by fibrovascular stroma (Fig. 2, staining with haematoxylin and eosin), pT2N1M0. The patient was treated by adjuvant chemotherapy (FOLFOX) and no recurrence was observed (last follow-up, April 2014). MRI diffusion-weighted imaging is a new modulation of MRI that can be used to assess abdominal staging of digestive tumours [1]. In this case, the MRI diffusion-weighted imaging was performed for a suspected hepatocellular carcinoma, allowing the fortuitous diagnosis of a gastric carcinoma. This is the first report of MRI diffusion-weighted imaging of HAC, a rare alpha fetoproteinproducing carcinoma arising in extra-hepatic organs. All diseases which exhibit inflammation or hypercellularity may have an increased MRI-diffusion signal. Reference
∗ Corresponding author at: Gastroenterology and Digestive Oncology, Avicenne Hospital, APHP, Paris 13 University, 125 rue de Stalingrad, 93000 Bobigny, France. Tel.: +33 1 48 95 54 31; fax: +33 1 48 95 54 39. E-mail address: [email protected] (T. Aparicio).
[1] Soussan M, Des Guetz G, Barrau V, et al. Comparison of FDG-PET/CT and MR with diffusion-weighted imaging for assessing peritoneal carcinomatosis from gastrointestinal malignancy. European Radiology 2012;22:1479–87.
http://dx.doi.org/10.1016/j.dld.2014.08.044 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
