case_images: PMC6625974_01
case_images: Axial CT venous phase (January 2016) demonstrated the irregular wall thickening of the subcardial lesser curvature (arrow) referable to the primary gastric neoplasm.
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case_images: PMC6625974_01_gr1.jpg
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case_images: Toshiba Medical Systems, Outerwear, Japan), that showed the subcardial neoplasm measuring about 25 x 15 mm (Fig. 1) without sign of distant metastases. The patient had a family history of gastric adenocarcinoma, his mother being affected.
case_images: Sagittal TSE T2-weighted image (July 2015) showing no abnormal findings in the L5-S1 foraminal space (a). Sagittal TSE T2-weighted image (b), axial TSE T2-weighted image (c) and sagittal fat-sat TSE T2-weighted image (d) showing a hyperintense round-shaped lesion involving the right L5-S1 foraminal space. Sagittal SE T1-weighted image (e) showing an hypointense mass in the L5-S1 foraminal space; coronal (f) and axial (g) fat-sat SE T1-weighted image after intravenous contrast administration showing avid enhancement of the lesion. 18F - FDG (18F-Fluorodeoxyglucose) CT-PET (Fig. 2h) showing focal hyperaccumulation within the sacral foramina of right S1 nerve root (SUV max. 5.2).
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case_images: PMC6625974_01_gr2.jpg
case_images: fig0010
case_images: T1-weighted images (repetition time [TR] 400 ms; echo time [TE] 14 ms; Fig. 2e), significant hyper-intense signal on TSE T2-weighted images (repetition time [TR] 3960 ms; echo time [TE] 114 ms; Fig. 2b-d), avid and homogeneous contrast enhancement on SE T1-weighted images (repetition time [TR] 400 ms; echo time [TE] 14 ms; Fig. 2f, g) enhanced by gadolinium-diethylenetriaminepenta-acetic acid (16 ml Dotarem, 0.2 ml/kg). The mass was not evident in the previous MRI (Fig. 2a) - CT (Fig. 3a) exams and was considerate suspicious for metastasis.
case_images: Axial CT venous phase (December 2017) showed no abnormal findings in the L5-S1 foraminal space (a). Axial CT venous phase (b), with coronal (c) and sagittal (d) reconstructions, showing the slightly hypervascular right-sided S1 nerve root mass. Axial CT bone window (e) showing initial erosive bone changes on right S1 sacral foramina. Histopathological examination stained with hematoxylin eosin (f) confirmed a metastasis of gastric adenocarcinoma.
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case_images: PMC6625974_01_gr3.jpg
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case_images: In clinical and radiological follow-up, the last on December 2017 (Fig. 3a), no local recurrence or metastases were observed.