Answer: 5. Hypertrophic gastritis

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Presentation transcript:

Answer: 5. Hypertrophic gastritis Total gastrectomy: Foveolar hyperplasia and glandular hyperplasia  Hypertrophic hypersecretory gastropathy (Hypertrophic gastritis)

Imaging findings (CT, EUS, EGD) Markedly thickened, lobulated folds in the gastric fundus and body Preservation of wall stratification without submucosal thickening Clear perigastric fat plane

Thickened Gastric Folds : DDx. Cause Distribution Comments Benign conditions Hypertrophic gastritis Fundus and Body Increased acid secretion Menetrier’s disease Hypochlorhydria and Hypoproteinemia Zollinger-Ellison syndrome Hypergastrinemia resulting from non-beta islet cell tumors Varices Fundus and Cardia Serpentine folds. Portal HTN or splenic v. obstruction Eosinophilic gastritis Antrum Peripheral eosinophilia Sarcoidosis Pulmonary sarcoidosis Amyloidosis Systemic amyloidosis Malignant Conditions Lymphoma Localized or Diffuse May have generazlied lymphoma Carcinoma Ass. Narrowing and regidity of stomach Gore and Levine, Textbook of Gastrointestinal Radiology, 3rd edition, p728

MDCT of Thickened gastric folds: DDx. Loss of wall stratification would be a predictor of the presence of malignancy in patients with thickened gastric folds A, B: normal gastric wall C: Scirrhous gastric carcinoma, D: Malignant lymphoma –Absence of wall stratification E: Acute gastric mucosal lesion, F: Menetrier’s disease –Preservation of wall stratification AJR 2010; 195: 1124-1130