323.Malignant gastric ulcer（恶性胃溃疡）
每天朗读一段医学影像学英语文章
Clinical Presentation：
A 57-year-old woman presents with mid-epigastric pain, nausea, vomiting, and weight loss.
Imaging Findings：
(A) Single-contrast study of the stomach shows a 1cm ulcer crater (arrow) along the greater curvature surrounded by a nodular, circumferential mass (arrowheads). The ulcer crater appears intraluminal rather than extending beyond the confines of the gastric lumen.
(B) Double-contrast study again shows the crater (arrow) surrounded by a circumferential mass. There are no radiating folds extending to the ulcer crater, and the adjacent gastric mucosa appears featureless. The nearby gastric rugae are markedly thickened.
Differential Diagnosis：
1.Malignant gastric ulcer
2.Benign gastric ulcer
Differential Diagnosis
1.Malignant gastric ulcer: This is indicated by an ulcer crater projecting within the confines of the gastric lumen; a nodular, circumferential mass surrounding the crater; featureless regional mucosa; and gastric folds failing to extend to the crater.
2.Benign gastric ulcer: This is far less likely, although markedly edematous folds surrounding a peptic ulcer can mimic the findings of a malignant ulcer.
Pearls & Pitfalls
·Malignant tumors cause only 5% of gastric ulcers.
·Benign peptic ulcers more commonly (95%) occur in the duodenum rather than in the stomach.
·Large, benign tumors may ulcerate.
·Anterior wall gastric ulcers are less common and more difficult to detect. They appear as rings of barium coating the crater edge.
·Chronic scarring from peptic ulcers can mimic radiating folds of active ulcers or mural findings of malignancy.
·Endoscopy should be recommended if malignancy is suspected.
Notes:
gastrointestinal /ˌɡæstroɪn'tɛstɪnl/ adj. 胃与肠的
nausea /'nɔzɪə/ n. 作呕;恶心;反胃
ulcer /'ʌlsɚ/ n. <医>溃疡
lumen /'lumɛn/ (管状器官内的）内腔
mucosa /mjʊ'kosə/ n. 黏膜
rugae /ɡaɪ/ n. [生][解]皱褶（ruga/'rʊgə/的复数）
duodenum /'dʊə'dinəm/ n. 十二指肠
ulcerate /'ʌlsəret/ vi. 形成溃疡，溃烂 vt. 使腐败；使溃疡
crater /'kretɚ/ n. 弹坑；火山口 vt. 在…上形成坑；取消；毁坏 vi. 形成坑；消亡
peptic /'pɛptɪk/ adj. 消化性的,助消化的,可消化的
来源：每天朗读一段医学影像学英语文章
圈主
深圳市人民医院放射科副主任医师杨敏洁