□ Fig. 44a-g. Patient D., age 67. Diagnosis: gastric cancer. a Stomach roentgenogram (tight filling, vertical position, anterior projection): uneven contour of the lesser curvature; an ulcer niche in the middle third (black arrow); disfigured and uneven contours of the abdominal segment of the esophagus (white arrow). b Stomach roentgenogram (double contrast, horizontal position, anterior projection): stomach body wall is thickened due to intramural infiltration (arrow). c Stomach roentgenogram (double contrast, horizontal position, left oblique projection): the anterior wall closer to the lesser curvature is thickened and rigid due to intramural infiltration spreading on to the upper part (arrows). Conclusion: Infil-trative-ulcerous cancer spreading to the abdominal segment of the esophagus. To verify spread of tumor infiltration to the neighboring anatomical structures, the patient underwent MRI examination. d MRI of the stomach (axial protection, T2 image): markedly thickened lesser curvature at the level of the upper part of the stomach extending to the anterior and posterior walls with heterogeneously reflected MR signal, ulcer crater, and overhanging edges of the infiltration ridge (arrows). e MR tomogram of the stomach (coronary projection, T2 image): tumor infiltration of the antral part wall (arrows); the pyloric part of the stomach is not changed. The inner contours of the stomach wall are uneven due to the presence of the ulcer (to 20 mm) located in the infiltrated wall of the stomach. Smaller foci emitting the hyperintensive MR signal are seen in the depth of the tumor infiltration. The outer contours of the stomach in its upper half are uneven and indistinct. Infiltration spreads to the region of the lesser omentum, the diaphragm (the region of the esophageal opening), the pancreas body, and the gastrocolic ligament. f MRI of the stomach (coronary projection, T1 image): thickened walls of the upper part with spread of intramural infiltration to the gastroesophageal junction zone. MR signal from the altered wall is of moderate intensity, heterogeneous due to the small hyperintensive foci (arrow). Conclusion: Infiltrative-ul-cerous cancer with propagation onto the abdominal segment of the esophagus, the lesser omentum region, the diaphragm (the zone of the esophageal opening), the pancreas body, and the gastrocolic ligament. g Fragment of a macrospecimen (strip): stomach wall is thickened due to white tumor infiltration growing through all its layers (arrows)
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