calcified target lesion: Mucinous carcinoma of the stomach

Abstract

Calcification of schirrous carcinoma of the stomach has been rarely shown by x-ray.'Y2 In the cases previously reported, the diagnosis was made by plain x-ray of the abdomen or by barium study of the stomach and d u~d e n u m .~,~ We have had the opportunity to make the diagnosis of calcified neoplasia of the stomach by ultrasonography of the abdomen in two patients. The present communication is a report of the findings in these two cases. CASE REPORTS Case 1A 53-year-old man clinically suspected of peritoneal carcinomatosis underwent an ultrasonographic examination of the abdomen. This examination disclosed a large mass involving the stomach (target lesion) with multiple parietal calcifications (Fig. 1). Ascites and enlarged lymph nodes were also identified.The findings were highly suggestive of a mucinous adenocarcinoma of the stomach. After sonography, a plain x-ray of the abdomen was performed, disclosing opacification of the abdomen as a result of ascites and multiple calcifications in the epigastric region. The ultrasonographic information was confirmed by a barium study of the stomach and duodenum (Fig. 2), where a dilated esophagus was also demonstrated. Gastrointestinal endoscopy showed a nonelastic gastric mucosa with signs of an exten- sive infiltrative process, mainly in the distal half of the stomach; the duodenum was normal.Biopsies of the gastric mucosa were taken for histopathologic studies. Laparoscopy showed a congestive parietal peritonium with whitish nodules, sometimes having a gelatinous appearance, tending to form masses. The liver and greater omentum were covered with ascites and gelatinous material. The biopsy disclosed a signet cell, poorly differentiated adenocarcinoma with desmoplastic reaction. Case 2A 68-year-old man was admitted to the hospital complaining of pain in the epigastric region and significant weight loss in the last 2 months. An ultrasonographic examination was done, which revealed a mass involving the stomach and parietal calcifications (Fig. 3). The liver was homogeneous, and metastases were not observed.Endoscopy of the stomach and duodenum showed an infiltrative process of the gastric antrum. A mucosecretory carcinoma of the stomach was found in the histopathologic study.