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AA.Gastric C II 06. ppt

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GASTRIC ADENOCARCINOMA<br />

Dissemination. I.<br />

* by direct extension through gastric wall to perigastric<br />

tissues (occasionally adhering to adjacent organs such<br />

as pancreas, colon or liver);<br />

- via lymphatics to intraabdominal (frequent) and<br />

supraclavicular lymph nodes (Troisier’ sign);<br />

- by seeding of peritoneal surfaces [metastatic<br />

nodules to ovary (Krukenberg's tumor), periumbilical<br />

region ("Sister Mary Joseph node") or peritoneal cul-desac<br />

(Blumer's shelf)];<br />

- malignant ascites;<br />

- hematogenous spread (more frequently to liver)

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