Case 3

This is a CT abdomen and pelvis study acquired post IV contrast administration in the portal venous phase – it demonstrates bulky, mass-like thickening of the gastric fundus and cardia walls; it shows normal soft tissue post contrast enhancement. There is also a rounded soft tissue lesion posterior to the body of the stomach, which shows the appearance of an enlarged lymph node.

I note that the oesophagus does not appear dilated, indicating that the mass is not causing luminal obstruction.

The radiological findings are most concerning for gastric lymphoma rather than adenocarcinoma. I would recommend upper endoscopy to obtain a biopsy in the first instance. PET-CT may also be performed, where lymphoma is expected to show very high FDG uptake (significantly higher than adenocarcinoma). This should be followed by discussion at the relevant MDT.