MIMICRY AND DECEPTION IN THE DIAGNOSIS OF TUMORS OF THE GASTRIC CARDIA

Although carcinoma of the cardia of the stomach is clearly the most important neoplasm of the area from the standpoint of diagnosis, the various other tumors and non-neoplastic conditions which may appear as masses in the cardia and mimic a carcinoma present difficult diagnostic problems.

Confirmation of the presence of a true mass lesion is the single most important additional diagnostic study. Repeat upper gastrointestinal series with attention to the area is the simplest means to do this. Some technical modifications for the study of this area are suggested. By this means most pseudotumors and non-neoplastic conditions mimicking a cardia carcinoma can be eliminated. Particular attention should be given to the possibility of a hiatus hernia, for pseudotumors are often associated with this abnormality.

Additional roentgenographic techniques such as barium enema examination, tomography, arteriography, and radioisotope scanning may be helpful in establishing the correct preoperative diagnosis. The gastric camera is a potentially valuable aid in evaluating this area. It can confirm the presence of a mass, and may reveal its etiology.

Thus, although many pseudotumors and tumors or other abnormalities of the cardia or adjacent organs or structures may mimic a carcinoma of the cardia in the initial upper gastrointestinal series, the use of additional roentgenographic techniques and the gastric camera should make it possible to eliminate many or most of these.

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