RESUMO
BACKGROUND: Adult-onset Ménétrier's disease is strongly associated with Helicobacter pylori (H. pylori) infection and an elevated risk of carcinogenesis. Cases of early-stage gastric cancer developed in H. pylori-negative Ménétrier's disease are extremely rare. We report a case of early gastric cancer in H. pylori-negative Ménétrier's disease that was curatively resected with endoscopic submucosal dissection (ESD). CASE SUMMARY: A 60-year-old woman was referred to our hospital after her medical examination detected anemia. Contrast-enhanced upper gastrointestinal (UGI) radiography revealed translucency of the nodule-aggregating surface with giant rugae. Blood tests showed hypoproteinemia and were negative for serum H. pylori immunoglobulin G antibodies. The 99mTc-DTPA-human serum albumin scintigraphy showed protein loss from the stomach. UGI endoscopy showed a 40-mm protruding erythematous lesion on giant rugae of the greater curvature of lower gastric body, suggesting early-stage gastric cancer due to Ménétrier's disease. En bloc resection with ESD was performed for diagnosis and treatment. Histology of ESD showed well-differentiated tubular adenocarcinoma. The cancer was confined to the mucosa, and complete curative resection was achieved. Foveolar hyperplasia and atrophy of the gastric glands were observed in non-tumor areas, histologically corresponding to Ménétrier's disease. Three years after ESD, gastric cancer had not recurred, and Ménétrier's disease remained in remission with spontaneous regression of giant gastric rugae. CONCLUSION: Complete curative resection was achieved through ESD in a patient with early-stage gastric cancer and H. pylori-negative Ménétrier's disease.
Assuntos
Ressecção Endoscópica de Mucosa , Gastrite Hipertrófica , Helicobacter pylori , Neoplasias Gástricas , Adulto , Feminino , Gastrite Hipertrófica/diagnóstico , Gastrite Hipertrófica/diagnóstico por imagem , Gastroscopia , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Gástricas/patologiaRESUMO
A 57-year-old man, on octreotide treatment for metastatic neuroendocrine tumor pancreas, was referred for whole-body Ga-DOTANOC PET/CT scan to evaluate treatment response. PET/CT scan revealed DOTANOC-avid lesion in the head of the pancreas with multiple tracer-avid soft tissue lesions in the liver, bilateral adrenal glands, and periportal lymph nodes. In addition, diffuse intense DOTANOC-avid mural thickening with intraluminal polypoidal mass formation was noted within the stomach causing significant luminal compromise, histopathological examination of which turned out be hypertrophic hypersecretory gastropathy. This case highlights the possibility of overexpression of somatostatin receptors in gastric hypertrophy, which has been little explored in literature.
Assuntos
Gastrite Hipertrófica/diagnóstico por imagem , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Compostos Organometálicos , Neoplasias Pancreáticas/patologia , Compostos RadiofarmacêuticosAssuntos
Gastrite Hipertrófica/patologia , Doença Relacionada a Imunoglobulina G4/patologia , Idoso , Biópsia , Feminino , Mucosa Gástrica/patologia , Gastrite Hipertrófica/diagnóstico por imagem , Gastroscopia/métodos , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Imuno-Histoquímica , Pancreatite/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
IgG4 related disease is a systemic autoimmune disease, which can affect different organs. The most common digestive manifestation is autoimmune pancreatitis (AIP), followed by involvement of bile ducts and the major papilla. The stomach is only rarely involved. We report a 71-year-old diabetic woman consulting for jaundice and weight loss. Abdominal CAT scan, cholangio resonance imaging, endosonography and a serum IgG4 of five times the normal value, lead to the diagnosis of an autoimmune pancreatitis. An upper gastrointestinal endoscopy showed a diffuse thickening of gastric folds. The pathological study confirmed the presence of IgG4 positive plasma cells. The patient was successfully treated with steroids.
Assuntos
Humanos , Feminino , Idoso , Doença Relacionada a Imunoglobulina G4/patologia , Gastrite Hipertrófica/patologia , Pancreatite/patologia , Biópsia , Imuno-Histoquímica , Tomografia Computadorizada por Raios X/métodos , Gastroscopia/métodos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Mucosa Gástrica/patologia , Gastrite Hipertrófica/diagnóstico por imagemAssuntos
Humanos , Masculino , Lactente , Edema/complicações , Gastrite Hipertrófica/diagnóstico , Oligúria , Vômito , Albumina Sérica/uso terapêutico , Ganciclovir/uso terapêutico , Diarreia , Diuréticos/uso terapêutico , /uso terapêutico , Gastrite Hipertrófica/etiologia , Gastrite Hipertrófica/tratamento farmacológico , Gastrite Hipertrófica/terapia , Gastrite Hipertrófica/diagnóstico por imagemAssuntos
Adenocarcinoma/diagnóstico por imagem , Gastrite Hipertrófica/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adolescente , Feminino , Gastrite Hipertrófica/complicações , Gastrite Hipertrófica/patologia , Humanos , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios XAssuntos
Humanos , Feminino , Adolescente , Neoplasias Gástricas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Gastrite Hipertrófica/diagnóstico por imagem , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Tomografia Computadorizada por Raios X , Gastrite Hipertrófica/complicações , Gastrite Hipertrófica/patologiaAssuntos
Gastrite Hipertrófica/diagnóstico , Neoplasias Gástricas/diagnóstico , Biópsia , Diagnóstico Diferencial , Gastrite Hipertrófica/complicações , Gastrite Hipertrófica/diagnóstico por imagem , Gastrite Hipertrófica/patologia , Gastroscopia , Humanos , Hipoalbuminemia/etiologia , Masculino , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
A 54-year-old man presented to our department with abdominal discomfort and anorexia and was diagnosed as having Ménétrier's disease (MD) with hilar cholangiocarcinoma. Based on his clinical examination, there was no evidence of Helicobacter pylori or cytomegalovirus (CMV) infection. Although we administered proton pump inhibitor and high-calorie enteral nutrition, hypoproteinemia did not improve, and the refractory protein-losing enteropathy persisted. However, interestingly, MD improved immediately after resection of the hilar cholangiocarcinoma. Generally, the etiology of MD is unknown, but H. pylori and CMV infections have been implicated. To our knowledge, there has been no previous report indicating that a malignant tumor could be involved in the etiology of MD. Thus, we report an extremely rare case of MD which is seemingly caused by malignancy.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Gastrite Hipertrófica/etiologia , Tumor de Klatskin/complicações , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/terapia , Biópsia , Gastrite Hipertrófica/diagnóstico por imagem , Gastrite Hipertrófica/patologia , Humanos , Tumor de Klatskin/diagnóstico por imagem , Tumor de Klatskin/terapia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Carcinoma/veterinária , Neoplasias do Colo/veterinária , Doenças do Cão/patologia , Omento/patologia , Neoplasias Peritoneais/veterinária , Neoplasias Gástricas/veterinária , Animais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/secundário , Diagnóstico Diferencial , Doenças do Cão/diagnóstico por imagem , Cães , Gastrite Hipertrófica/diagnóstico por imagem , Gastrite Hipertrófica/patologia , Gastrite Hipertrófica/veterinária , Imageamento por Ressonância Magnética/veterinária , Masculino , Mesentério/diagnóstico por imagem , Mesentério/patologia , Invasividade Neoplásica , Omento/diagnóstico por imagem , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologiaRESUMO
Ménétrier disease is a very rare chronic gastric disorder characterized by gastric mucosal hypertrophy. We present a case of Ménétrier disease with CT, MRI, and FDG PET/CT findings. Enhanced CT and MRI showed diffuse thickened mucosa of the greater curvature and elongated mucosa of the antrum with remarkable enhancement. The early and delayed FDG PET/CT showed increased FDG uptake of these thickened mucosa. The increased FDG uptake may be due to the mucosal inflammation. This case indicates Ménétrier disease should be included in the differential diagnosis of abnormal gastric FDG accumulation along with tumor and nontumor processes.
Assuntos
Fluordesoxiglucose F18 , Gastrite Hipertrófica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos Radiofarmacêuticos , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
We report a 47-year-old man in whom Tc human serum albumin diethylene-triamine-pentaacetic acid protein-losing scintigraphy, performed with SPECT/CT, was useful for diagnosing Ménétrier disease. Planar images taken 1 and 3 hours after radioactive isotope injection yielded a suspicion that the stomach was the site of protein loss in this case. However, the protein loss from the stomach was precisely diagnosed after SPECT/CT was performed; this helped to diagnose Ménétrier disease.
Assuntos
Gastrite Hipertrófica/diagnóstico por imagem , Imagem Multimodal , Estômago/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Pentetato de Tecnécio Tc 99mRESUMO
Molecular imaging biomarkers of proliferation hold great promise for quantifying response to personalized medicine. One such approach utilizes the positron emission tomography (PET) tracer 3'-deoxy-3'[18F]-fluorothymidine ([18F]FLT), an investigational agent whose uptake reflects thymidine salvage-dependent DNA synthesis. The goal of this study was to evaluate [18F]FLT-PET in the setting of Ménétrier's disease (MD), a rare, premalignant hyperproliferative disorder of the stomach treatable with cetuximab therapy. Over 15 months, a patient with confirmed MD underwent cetuximab therapy and was followed with sequential [18F]FLT-PET. For comparison to MD, an [18F]FLT-PET study was conducted in another patient to quantify uptake in a normal stomach. Prior to cetuximab therapy, stomach tissue in MD was easily visualized with [18F]FLT-PET, with pre-treatment uptake levels exceeding normal stomach uptake by approximately fourfold. Diminished [18F]FLT-PET in MD was observed following the initial and subsequent doses of cetuximab and correlated with clinical resolution of the disease. To our knowledge, this study reports the first clinical use of [18F]FLT-PET to assess proliferation in a premalignant disorder. We illustrate that the extent of MD involvement throughout the stomach could be easily visualized using [18F]FLT-PET, and that response to cetuximab could be followed quantitatively and non-invasively in sequential [18F]FLT-PET studies. Thus, [18F]FLT-PET appears to have potential to monitor response to treatment in this and potentially other hyperproliferative disorders.
Assuntos
Anticorpos Monoclonais Humanizados/farmacologia , Didesoxinucleosídeos , Gastrite Hipertrófica/diagnóstico por imagem , Gastrite Hipertrófica/tratamento farmacológico , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Anticorpos Monoclonais Humanizados/uso terapêutico , Cetuximab , Feminino , Gastrite Hipertrófica/patologia , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This study reports a case of Ménétrier's disease (MD) in an adult who presented with epigastric pain and peripheric edema. We focused in particular on the imaging and diagnostic aspects of the presenting case as well as clinical, histologic, and therapeutic aspects. Computed tomography (CT) enteroclysis is a new imaging technique which combines enteroclysis and spiral multislice CT. To the best of our knowledge this is the first report on a MD in an adult patient diagnosed by CT Enteroclysis.