Findings :
Multiple hypervascular hepatic lrsions, with central low attenuation, intense enhanced in the arterial phase, washed out the contrast in portovenous and delayed phases .
Intensely enhancing nodule was seen at the wall of the greater curvature of the stomach, with focal retraction of the wall.
Normal appearance of the other organs namely the thyroid gland, mediastinal structures, pancreas, adrenal glands, both kidneys , the bowel loops mainly the region of terminal ilium and appendix.
Clue for the diagnosis :
Whenever you have multiple hypervascular hepatic tumors, in a normal non-cirrhotic liver parenchyma , with a malignant behavior ( wash out the contrast ) , you have to put in your mind a metastatic process from a primary hypervascular tumor which are about 7 tumors:
1- Thyroid carcinoma
2- Choriocarcinoma
3- Renal cell carcinoma
4- Iselet cell tumors of pancreas
5- Malignant pheochromocytoma
6- Malignant melanoma
7- Carcinoid tumor
8- 15% of cancer breast
In the demonstrated case, the suspicious primary sites ( thyroid , kidneys, pancreas, adrenal, mediastinal structures ) were unremarkable, and the only stricking finding was an enhancing nodule seen at the gastric wall , and because carcinoid tumor was the only remaining differential diagnosis for such hypervascular metastasis , although it rarely involves the stomach ( 3% only ), so I raised the possibility of carcinoid tumor of the stomach specially in the presense of focal retraction of the gastric wall due to the desmoplastic reaction of the carcinoid , and the diagnosis is confirmed later on after biopsy from the gastric nodule.
Diagnosis
Carcinoid tumor of the stomach with hypervascular metastasis to the liver
Multiple hypervascular hepatic lrsions, with central low attenuation, intense enhanced in the arterial phase, washed out the contrast in portovenous and delayed phases .
Intensely enhancing nodule was seen at the wall of the greater curvature of the stomach, with focal retraction of the wall.
Normal appearance of the other organs namely the thyroid gland, mediastinal structures, pancreas, adrenal glands, both kidneys , the bowel loops mainly the region of terminal ilium and appendix.
Clue for the diagnosis :
Whenever you have multiple hypervascular hepatic tumors, in a normal non-cirrhotic liver parenchyma , with a malignant behavior ( wash out the contrast ) , you have to put in your mind a metastatic process from a primary hypervascular tumor which are about 7 tumors:
1- Thyroid carcinoma
2- Choriocarcinoma
3- Renal cell carcinoma
4- Iselet cell tumors of pancreas
5- Malignant pheochromocytoma
6- Malignant melanoma
7- Carcinoid tumor
8- 15% of cancer breast
In the demonstrated case, the suspicious primary sites ( thyroid , kidneys, pancreas, adrenal, mediastinal structures ) were unremarkable, and the only stricking finding was an enhancing nodule seen at the gastric wall , and because carcinoid tumor was the only remaining differential diagnosis for such hypervascular metastasis , although it rarely involves the stomach ( 3% only ), so I raised the possibility of carcinoid tumor of the stomach specially in the presense of focal retraction of the gastric wall due to the desmoplastic reaction of the carcinoid , and the diagnosis is confirmed later on after biopsy from the gastric nodule.
Diagnosis
Carcinoid tumor of the stomach with hypervascular metastasis to the liver