EURORAD ESR

Case 13342

Perirenal neoplastic recurrence from adenocarcinoma of the gastric cardia

Author(s)
Tonolini Massimo, M.D.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 45 year(s)
 
 
  • Figure 1
    Preoperative contrast-enhanced CT + Early postoperative upper GI series
     

    After neoadjuvant chemotherapy, CT with gastric distension (oral water) and hypotonisation showed residual adenocarcinoma of the gastric cardia as focal enhancing mural thickening (short arrows) without extramural...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    After neoadjuvant chemotherapy, CT with gastric distension (oral water) and hypotonisation showed residual adenocarcinoma of the gastric cardia as focal enhancing mural thickening (short arrows) without extramural...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    A few days after surgery, upper gastrointestinal series with water-soluble contrast showed complete gastrectomy with patent Roux-en-Y anastomosis (arrowhead). Note drainage tube in place (short arrow).

     
    Area of Interest: Stomach; Imaging Technique: Fluoroscopy; Procedure: Surgery; Special Focus: Neoplasia;
     
     
  • Figure 2
    Post-surgical contrast-enhanced CT, before adjuvant chemotherapy initiation
     

    Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;
     
     
  • Figure 3
    Current contrast-enhanced CT during adjuvant chemotherapy
     

    Coronal images (a...c) showed appearance of left-sided pleural effusion (+) and atelectatic basal lung consolidation, mild pelvic ascites (*), left kidney surrounded by small-sized poorly enhancing solid masses...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Coronal images (a...c) showed appearance of left-sided pleural effusion (+) and atelectatic basal lung consolidation, mild pelvic ascites (*), small-sized poorly enhancing solid masses (arrows) occupying most of the...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Detail coronal image showed delayed nephrographic phase of left kidney surrounded by small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space. Note ipsilateral pleural effusion and...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Axial detail images (d..f) showed delayed nephrographic phase of left kidney surrounded by small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space.

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Note small-sized poorly enhancing solid masses (arrows) consistent with metastatic deposits occupying most of the perirenal space, one (arrowhead) in the site of the lateral arm of the adrenal gland.

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    The delayed nephrographic appearance of the left kidney was attributable to hypoperfusion from metastatic deposits (arrows) compressing the vascular pedicle. Note mildly prominent mesenterial lymph nodes (thin arrow).

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;
     
     
  • Figure 4
    Last contrast-enhanced CT during clinical deterioration
     

    Three months later, repeated CT showed persistent pleural effusion (+), increased ascites (*), appearance of 4 small-sized hypovascular liver metastases (short arrows).

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Three months later, repeated CT showed persistent pleural effusion (+), increased ascites (*), appearance of 4 small-sized hypovascular liver metastases (short arrows).

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    The metastatic deposits of the left perirenal space appeared to be decreased in number and size. Note ascites (*).

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    The metastatic deposits of the left perirenal space appeared to be decreased in number and size. Additionally, increased size of some mesenterial lymph nodes (thin arrows) was noted. Note ascites (*), small-sized...

     
    Area of Interest: Stomach; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;
     
     
After neoadjuvant chemotherapy, CT with gastric distension (oral water) and hypotonisation showed residual adenocarcinoma of the gastric cardia as focal enhancing mural thickening (short arrows) without extramural invasion. No nodal or distant metastases.
 
After neoadjuvant chemotherapy, CT with gastric distension (oral water) and hypotonisation showed residual adenocarcinoma of the gastric cardia as focal enhancing mural thickening (short arrows) without extramural invasion. No nodal or distant metastases.
 
A few days after surgery, upper gastrointestinal series with water-soluble contrast showed complete gastrectomy with patent Roux-en-Y anastomosis (arrowhead). Note drainage tube in place (short arrow).
 
Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality in the perirenal space.
 
Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality in the perirenal space.
 
Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality in the perirenal space.
 
Axial images in craniocaudal order showed normal post surgical status after complete gastrectomy and nodal dissection. Note metallic clips, normal left adrenal gland (arrowheads), no signs of recurrence or abnormality in the perirenal space.
 
Coronal images (a...c) showed appearance of left-sided pleural effusion (+) and atelectatic basal lung consolidation, mild pelvic ascites (*), left kidney surrounded by small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space.
 
Coronal images (a...c) showed appearance of left-sided pleural effusion (+) and atelectatic basal lung consolidation, mild pelvic ascites (*), small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space.
 
Detail coronal image showed delayed nephrographic phase of left kidney surrounded by small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space. Note ipsilateral pleural effusion and atelectatic basal lung consolidation.
 
Axial detail images (d..f) showed delayed nephrographic phase of left kidney surrounded by small-sized poorly enhancing solid masses (arrows) occupying most of the perirenal space.
 
Note small-sized poorly enhancing solid masses (arrows) consistent with metastatic deposits occupying most of the perirenal space, one (arrowhead) in the site of the lateral arm of the adrenal gland.
 
The delayed nephrographic appearance of the left kidney was attributable to hypoperfusion from metastatic deposits (arrows) compressing the vascular pedicle. Note mildly prominent mesenterial lymph nodes (thin arrow).
 
Three months later, repeated CT showed persistent pleural effusion (+), increased ascites (*), appearance of 4 small-sized hypovascular liver metastases (short arrows).
 
Three months later, repeated CT showed persistent pleural effusion (+), increased ascites (*), appearance of 4 small-sized hypovascular liver metastases (short arrows).
 
The metastatic deposits of the left perirenal space appeared to be decreased in number and size. Note ascites (*).
 
The metastatic deposits of the left perirenal space appeared to be decreased in number and size. Additionally, increased size of some mesenterial lymph nodes (thin arrows) was noted. Note ascites (*), small-sized liver metastasis (short arrow).
 
 
 
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