A 60yr ols male presented withnpain abdomen . h/o weight loss , night sweats and loss of appetite. Patient was investigated, reports attached. Pls discuss how to proceed ????

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Imaging wise the diagnosis favours linitis plastica with d3 lymph nodes (paraortic Ln on scan) but constitutional symptoms could well be B symptoms of lymphoma. If adenoca the prognosis is poor, though paraortic Ln +ve pts fare better than stage 4 ones. It would be worthwhile assessing the Patient after 3# chemo (ECF, EOX, DCF, TPF). As mentioned by Dr. Venkata, worthwhile to do IHC for Her2 if adenoca confirmed. If lymphoma then only chemo. Surgery will then be required only of residual disease.
tb abdomen ct &blood invtgns needed
rule out tuberculosis
this is a case of carcinoma stomoch.. first stage it properly.. PET tends to overstage.. go for endoscopic ultrasound and CECT abdomen.. also do pleural tapping and send for cytology, chest xray and CT thorax.. FNAC from thyroid nodule.. if no evidence of metastatic disease is found and the lesion is found resectable then go for diagnostic laparoscopy and then proceed for surgery.. if disease is found metastatic or unresectable then send the pt for chemotherapy
Endoscopy with repeat biopsy and IHC, pleural fluid cytology to be done. If disease is non metastatic then to proceed with neoadjuvant chemotherapy, assessment of the response with PET and surgery ( total gastrectomy with D2 node dissection +/- distal pancreatectomy/ splenectomy if involved) followed by adjuvant chemotherapy +/- radiation therapy. If metastatic, then chemotherapy.
The picture mostly goes with gastric lymphoma TypeB but sometimes it is difficult to diagnose due to deep involvement of submucosa so it's advisable to confirm the diagnosis by EUS and if so the best treatment will be chemotherapy as there is nodal involvement but if it's adenocarcinoma ,it will be managed as palliatively like stenting and chemotherapy
1. Possibly malignancy: either lymphoma or adenocarcinoma Linitus plastica. 2. A good biopsy is advised. If negative, a good sample from lymph node is advised. may be laparoscopic. 3. If adenocarcinoma, very poor prognosis. palliative chemo. However, Lymphoma can be treated with curative intent. risk of perforation is very high!
Gastric Lymphoma is one possible DD to Adenocarcinoma in this Scenario.. Is there any h/o fever? I would suggest Repeat Endoscopy guided biopsy and/or U/S guided or CT guided biopsy from the largest node at Perigastric location for HPE and Immunohistochemistry including markers for Lymphoma - LCA/CD45, CD20, Cytokeratin, Her2Neu
In case of Gastric adenocarcinoma following 4 to cycles of EOX repeat PET CT for Response and if feasible proceed for Total Gastrectomy and D2 lymph node dissection followed by adjuvant Chemotherapy completion upto 8 cycles +/- Radiation therapy.
Inj.Trastuzumab may be added to EOX regimen if IHC for HER 2 neu is positive. In case of final dx of NHL after HPE and IHC CHOP +/- Inj. Rituximab for 6 to 8 cycles with PET-CT for Response after 3 to 4 cycles and at the end would be ideal
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