RADIOLOGY: GASTROINTESTINAL: GI: Case# 90: GASTRIC CA. 59 year old male with early satiety, weight loss, and abdominal pain. The gastric wall is diffusely moderately thickened. The thickened wall has lost its usual laminar appearance. This thickening extends up to the GE junction and down to the pyloris. No abnormally enlarged regional lymph nodes are identified. Gastric adenocarcinoma is the third most common GI malignant neoplasm. Most gastric cancers arise in the distal stomach. Morphologic types include exophytic, diffusely infiltrative, and ulcerating. The above images depict the diffusely infiltrative type, also known as linitis plastica. Wall thickening (with an adequately distended gastric lumen) and loss of the normal rugal folds may be seen on CT imaging. The abnormally thickened wall may exhibit enhancement after contrast administration. Gastric carcinoma spreads via four mechanisms:  hematogenous dissemination to liver and lungs  direct extension to porta hepatis (along gastrohepatic ligament) and transverse colon (along gastrocolic ligament)  lymphatic spread to regional nodes  intraperitoneal spread to peritoneum and peritoneal surfaces of bowel.