To investigate the enhanced multislice spiral CT (MSCT) features of hepatoid adenocarcinoma of the stomach (HAS) with liver metastasis.

Eight cases of histologically proven HAS between February 2013 and February 2022 in The First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. All 8 patients underwent contrast-enhanced abdominal CT scanning, of which 4 were preoperative radical gastrectomy. There were 6 males and 2 females, with a median age of 64 years. Imaging parameters were analyzed, including enhancement mode of arterial and venous phases, necrosis, venous thrombosis and overall imaging diagnosis.

The gastric lesions were located in the fundus of stomach and cardia (4/8, 50%), antrum of stomach (3/8, 37.5%) and fundus of stomach (1/8, 12.5%). Preoperative images of 4 gastric lesions were analyzed. The maximum thickness of gastric wall was (22.02±3.64) mm, and the general types were protuberance type in 2 cases, ulcer type in 1 case and infiltration type in 1 case. The tumor showed soft tissue density mass on plain scan, and 2 cases showed low density necrosis area. No calcification was found. In arterial phase, 3 cases showed obvious enhancement, 1 case showed moderate enhancement, and 2 cases showed uneven enhancement due to intra-tumor necrosis. Among the 8 cases of HAS liver metastases, 6 cases were multiple, and 2 cases were single. Axial MSCT showed that the largest liver metastases in 7 patients were > 3 cm, and necrosis was visible regardless of size. The boundaries of the cancer lesions were clear in 6 cases. The reinforcement was uneven, and 3 cases showed ring reinforcement. There were 6 cases of mild reinforcement in the arterial phase and 2 cases of moderate intensification, typical "fast forward and fast out" mode. There were 7 cases with lymph node metastasis, 3 cases with portal vein invasion and 1 case with pancreatic metastasis.

The typical MSCT manifestation of primary gastric cancer is a soft tissue density mass with gastric wall thickening >2 cm, which may be accompanied by necrosis and rare calcification. Enhanced scanning shows moderate to obvious continuous enhancement. The enhanced MSCT findings of liver metastases are similar to primary liver cancer (HCC), but patients often have no risk factors for HCC, and the tumor necrosis rate is high. It is often complicated with lymph node enlargement in abdominal cavity and around stomach, and some of them may be complicated with other abdominal organs such as pancreatic metastasis.