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Gastric Adenocarcinoma

Primary gastric adenocarcinoma is extremely rare in children; it represents only 0.05% of all malignant pediatric gastrointestinal tumors (SAsAKi et al. 1999). Nearly 10% of all gastric cancers will present in patients younger than 41 years (Kokkola and SippONEN 2001). There are three different forms of presentation in the pediatric population: de novo, as part of a polyposis syndrome (e.g. Peutz-Jeghers syndrome as mentioned above) and following treatment of a gastric lymphoma (Dokucu et al. 2005). The prognosis of these patients is very compromised, as described by Dokucu et al. (2005) and Reut et al. (2001).

On upper GI series, loss of distensibility, distortion of the normal surface pattern of the stomach with thickened irregular folds and mucosal nodularity or irregular narrowing with or without ulceration (the ulcer is located intraluminally in contrast to a benign ulcer which is located beyond the expected border of the stomach) can be seen anywhere in the stomach (Fig. 3.22).

CT will be used for staging purposes to assess lymphadenopathy and to assess invasion of adjacent organs.

Fig. 3.22. a Multiple polyps (arrows) in Peutz-Jeghers with malignant degeneration (adenocarcinoma). b This 12-year-old had a giant osteoma in the left frontal sinus: Gardner syndrome

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