X-ray Diagnosis of Sarcoma of the Stomach Kenji Kumakura 1 1Dept. of Int. Med., Cancer Institute Hospital pp.271-284
Published Date 1970/3/25
DOI https://doi.org/10.11477/mf.1403111226
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 In the years 1946 to 1969, a series of 52 cases of gastric sarcoma have been operated on in the Department of Surgery, Cancer Institute Hospital, including 38 cases of malignant lymphoma (36 reticulum cell sarcomas, 1 lymphosarcoma and 1 Hodgkin's sarcoma), 12 cases of leiomyosarcoma and 2 other varieties of sarcoma (one a melanosarcoma and the other a neurilemoma). Of these, reticulum cell sarcoma, now most at issue, has been studied in this paper.

 Macroscopically it is classified into 4 types

 Ⅰ. Polypoid type

   a) pedunclated

   b) flat, elevated

   c) with thickened folds

 Ⅱ. Localized, ulcerating type

   a) exogastric

   b) intramural

   c) endogastric

 Ⅲ. Intermediate type

  1. Ulceration with no distinct marginal protrusion

   a) exogastric

   b) intramural

  2. Ulceration with giant folds around it

 Ⅳ. Diffuse type

  1. Giant folds

  2. Nodular or massive protrusion

  3. Ⅱc like

X-ray findings of reticulum cell sarcoma are as follows:

 (The polypoid type is so small in number that it is omitted here.) Ulcerating type (Ⅱ & Ⅲ) shows very similar findings to those of carcinoma of Borrmann's types Ⅱ and Ⅲ. In the localized, ulcerating type, a sharply demarcated smooth crater, almost characteristic of malignant lymphoma or reticulum cell sarcoma, is sometimes recognized. In the intermediate type, multiple ulcers are observed as well as giant rugae around them. Its exogastric type can sometimes be visualized as a pale shadow outside the stomach even in a simple x-ray picture. The most distinguishing feature of this variety is that narrowing of the gastric lumen is slight as compared with the extensiveness of the lesion. This is of utmost importance in the differentiation between it and cancer or benign tumors. Although it has been shown in the literature that lesions belonging to intermediate type should be discriminated from benign neoplasms, it was more of a problem in our cases to do so from reactive lymphoreticular hyperplasia. The diffuse type has such roentgenologic distinction as giant folds and nodular or massive protrusion, in addition to multiple ulcers of various sizes. These findings merit attention in the diagnosis of this variety of reticulum cell sarcoma. Most important of all, however, is the fact that narrowing of the gastric lumen is slight, if any, in comparison with the extent of the tumor. Unlike in the literature, 2cases of esophageal involvement have been experienced in our cases. No esophageal dilatation was seen, but there were distinct shadow defects in the lower segment of the esophagus in x-ray pictures.

 According to the literature, the differential diagnosis includes cancer, benign tumors and ulcers of the stomach as well as giant rugae. We think early gastric cancer and reactive lymphoreticular hyperplasia should be included in it as well.

Copyright © 1970, Igaku-Shoin Ltd. All rights reserved.


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