الموقع الرسمي للدكتور أحمد رفاعي

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Case No ; 1

12/12/2012

8 Comments

 
Picture
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


8 Comments
mohamed abdel aziz
12/12/2012 08:26:13 pm

Dear sir, your writing manner is simple and informative at the same time .. this is a sign that u r brilliant .. great work and great explanation , also page design is simple and i like it ..:)

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Ahmed Refaey
12/13/2012 01:16:41 am

thanks a lot dear Dr Mohammed

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Dr. Reema Bilal
12/13/2012 04:16:01 am

Jazak Allah

Reply
Ahmed Refaey
12/13/2012 01:50:30 pm

و جزاكى كل خير

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ayat
12/13/2012 05:01:03 am

please sir , provide more data in the history and clinical exam .

Reply
Ahmed Refaey
12/13/2012 01:52:49 pm

Ayat , do u mean more data in the history and clinical exam regarding this case , or in the next cases in the comming weeks ?

Reply
ayat
12/27/2012 05:13:32 am

the next cases in the comming weeks ,,,,thanks for replying

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Brittany Hunt link
8/11/2021 07:06:43 pm

This was great to read thank you

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