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Computed Tomography Findings in Gastric Intestinal Metaplasia

Arzu Turan, Seyma Tafrali and Fatma Beyazal Celiker
DOI: gsl.jccrr.2018.000029

Abstract

Because the prevalence of gastric cancer is high and its prognosis is poor in the general population, early diagnosis is important. For gastric cancer, risk factors and precancerous lesions are well known. For gastric cancer, computed tomography has an important role in diagnosis, staging and treatment planning. When we look at the literature for the diagnosis of precancerous lesion, which will be an early diagnosis guide, we did not find any information about imaging findings. Gastric intestinal metaplasia was a precancerous lesion and we retrospectively analyzed the computed tomography sections of three patients who underwent endoscopic examination. In the pathological specimen, we noticed that the intestinal metaplasia, gastric mucosal rachas, lasagna-like, lace-style, parallel to each other showed a rough coincidence. We believe that large-scale, prospective studies will increase the incidence of gastric intestinal metaplasia, a precancerous lesion, and contribute to the early diagnosis of gastric cancer.


Introduction

Insulinoma is the most common functioning neuroendocrine tumor of the pancreas and occurs with an incidence of 4 per million patients per year. It may be associated with other endocrine gland tumors in type I multiple endocrine neoplasia (MEN I). Although rare, is the main cause of endogenous hyperinsulinemic hypoglycemia. The male-to-female ratio for insulinomas is 2:3. No racial predilection appears to exist. The median age at diagnosis is 47 years old, except in patients with MEN 1, in whom the median age is the mid-20’s. The most common clinical manifestations are neurovegetative and neuroglycopenic symptoms secondary to hypoglycemia. Progressive weight gain is also an important clinical feature, due to the anabolic action of insulin and the need to feed periodically in an attempt to reduce hypoglycemia. The presence of neuroglycopenic symptoms, that sometimes may be confounded with psychiatric symptoms, may lead to delay or misdiagnosis. In our country, there are few publications about the early diagnosis and treatment of this neoplasm. Surgery still seems to be the best treatment option but, in selected case in which there are high surgical risk, the minimally invasive procedures, such as endoscopic ultrasound (EUS) guided ethanol ablation can be a good choice of treatment. We report a case of an insulinoma in a patient with extreme obesity that was submitted to a less invasive treatment due to surgical risks.

Case reports 

Case 1

The first case was a 79-year-old woman with Alzheimer’s disease who presented to our hospital with abdominal pain for the first time 7 years ago. He had many medical problems, including primary hypertension, hyperlipidemia, asthma, cellulite, gastric ulcer, gastro-esophageal reflux, and liver diseases. The tumor markers (CEA 125, CA19-9, CA15-3, AFP) and biochemical data were within normal limits at 6-month intervals. She was referred to our emergency department with the latest abdominal pain and was referred to the radiology department for abdominal CT. In an emergency setting, abdominal thickening of the stomach, anterior to the corpus-antrum junction of the stomach, in the form of lasagna-like lace, and rugal thickening were visualized. The patient was referred to endoscopic examination by the clinical unit, and a single localization biopsy was performed and no H. pylori and atrophy were observed in the endoscopic examination. Pathologic examination revealed chronic active gastritis, lymphoid aggregate presence, focal intestinal metaplasia in the epithelium and inflammation (Figure 1)

 


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