Calcifying mucinous adenocarcinoma of the stomach.

Abstract

The radiographic demonstration of calcification in gastric carcinoma is rare. Only 10 such cases have been described in the English literature, all mucin-producing adenocarcinomas (1–10). Our demonstration of gross calcification in 2 different gastric carcinomas in the past year prompted this report. A marked similarity in the type and distribution of the calcium was evident in our two patients as well as in the cases illustrated in previous reports. An awareness of the occurrence of this calcification is important inasmuch as most punctate left upper quadrant calcification indicates a benign process such as pancreatitis or old granulomatous disease of the spleen. The gastrointestinal examination, however, has demonstrated an obvious malignant process in each case reported in the literature as well as in our own two cases. Case I: A 46-year-old white male was admitted to the Durham, N. C, Veterans Administration Hospital with a six-month history of early satiety associated with nausea and vomiting, and a 30-lb. weight loss over this period. Physical examination revealed a large, easily palpable mass in the left upper quadrant of the abdomen. Roentgenograms demonstrated rather well defined, punctate calcification in the left upper quadrant (Fig. 1). An upper gastrointestinal examination showed a large annular tumor of the body of the stomach with retained secretions proximal to the lesion (Fig. 2). Surgical exploration disclosed a large, irregular, multilobulated annular tumor of the body of the stomach. The gross pathologic report described a white, very hard, coarsely granular tumor encircling the stomach with a maximum thickness of 9 mm. The histologic diagnosis was adenocarcinoma with many collections of mucous “lakes” containing amorphous calcium. Case II: A 46-year-old Negro male was admitted to Duke Hospital with intermittent, stabbing, periumbilical pain of twelve months duration. A loss of 35 lb. had occurred over an indeterminate period. Physical examination revealed an ill-defined epigastric fullness, but no definite mass could be palpated. Upper gastrointestinal examination showed rigid narrowing of the antrum and body of the stomach with irregular nodular projections into the lumen. There was obvious punctate calcification in the thickened wall of the stomach (Fig. 3). Surgical exploration disclosed a very large, obviously malignant tumor involving the entire antrum and most of the body of the stomach. The histologic diagnosis was adenocarcinoma producing mucin. Autopsy revealed a bulky, hard, white, granular neoplasm with sand-like particles of calcification apparent both on the surface of the tumor and on cut section. A radiograph of the stomach as removed at autopsy is shown in Figure 4.