benign tumors of the stomach

8/14/2019 BENIGN TUMORS OF THE STOMACH

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BENIGN TUMORS OF THE STOMACH

BACKGROUND

Approximately 7% ofpremortem gastric tumorare

benign.

A recent series of5554 patients undergoing upper

gastrointestinal endoscopy suggested an incidence of

0.8% of the total population screened.


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BACKGROUND

The mean age of the patient was 56 years,with a five-fold greater incidence in females.

Benign tumor constitute less than 2% of truegastric neoplasms found at the time ofautopsy.

Approximately 3% of those discovered at thetime ofendoscopy in symptomatic patients.


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BACKGROUND

Approximately 40% of these tumor are mucosalepithelial polyps, another 40% are leiomyomas.

And all the remaining types are rare.


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Polyps

Polyp is generally used to describe any growth that

protrudes into the gastric lumen.

Almost all gastric polyps arise from the mucosal

epithelium.


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Polyps

The nomenclature of gastric polyps is confusing

largely because ofearly attempts to present them as

being analogous to colorectal polyps in microscopic

appearance and natural history.


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Polyps

Polyps vary between 1 cm and 2 cm. in diameter and

have no predicable location within the stomach.

Multiple polyps in the same patient are almost always

of the same histologic type.


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Polyps

Hyperplastic polyps

Also know as regenerative, inflammatory,hyperplaslogenic, or hamartomatous polyps.

(constitute 75% of all gastric epithelial polyps)

They may vary in size from few millimeters toseveral centimeters.


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Polyps Hyperplastic polyps

Most are less than 2cm.

The gastric lesion termed polyadenomes polypeux

corresponds to multiple heperplastic polyps.

And cystic component referred to as gastristispolyposis cystica.


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Polyps

Neoplastic polyps or adenomas

These polyps are usually antral in location, are

usually single and large. (and may be sessile or

pedonculated).

They can be divided into adenomatous polyps

(tubular adenoma) and villous adenoma.


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Polyps Fundic gland polyps

They are fundic gland hyperplasia

polyps with fundic glandular cystic.

Present as multiple small polypoid projections in the

gastric fundus or body. ( They are common in FAPpatients)


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Polyps

Inflammatory fibroid polyps

Also known as eosinophilic granuloma,

granulomablastoma, neurofibroma, andhemangiopericytoma.


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Gastric polyps in polyposis syndromes

Gastric involvement occurs in over 50% of

patients with familial polyposis coli (FAP) and

related Gardner syndrome.


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Intramural Tumors Leiomyomas

Are the most common benign tumor of the stomachreported at autopsy.

There is a spectrum from benign to malignant.

The only reliable indicator of malignancy in these andother GISTs is evidence of extragastric spread


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Intramural Tumors

Leiomyomas These tumors can cause symptoms by obstruction,

ulceration, and blood loss or by compressing adjacent

organs.


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Heterotopic pancreas An aberrant rest of pancreas tissue located in the

wall of the stomach.

Presents clinically as a tumor and must be

considered in the differential diagnosis of benign

gastric neoplasms.


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Brunners Gland Adenoma.

Brunners gland adenoma can occur in the

antrum or juxtapyloric region, representing

heterotopic locations of a hamartomatous lesionthat is usually found in the duodenum.


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Hyperplastic Gastropathy

The general term hyperplastic gastropathy refers to a

rare condition in which there is enlargement of the

rugal folds in the stomach.

Polyadenome en nappe (Menetrier disease)

Multiple hyperplastic polyps


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Menetriers Disease

Is characterized by gastric mucosal hypertrophy

that may be so extensive that the rugae assume the

appearance ofconvolutions of the brain.


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Pseudolymphoma

This is extensive lymphocytic infiltration of a portion

of the stomach, Generally associated with a benign

gastric ulcer.


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Cystic tumors Cystic tumors can be mucocele or

intramucosal, and they are the most common

benign cystic lesion of the stomach.


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Clinical Presentation

History Benign gastric tumors occurs predominantly in the

middle decades of life.

And are most commonly located in the gastric

antrum or corpus.

Tumor of the cardia and pylorus proper are rare.


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History

Complaints may be:

Pain

Indigestion

Obstruction (vomiting)

Weight loss

or unexplained anemia (occult bloodloss??)


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History

Because of the propensity of these tumors to

ulcerate the associated mucosal epithelium, theresultant occult blood loss can cause iron-deficiency

anemia.


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History

Deep ulcerations that overlie intramural tumors

are notorious for their association with overt

hemorrhage. Bleeding hematemesis,

melena

Ulceration may cause syndrome indistinguishable

from that caused by peptic ulcer disease.


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History

Patients may therefore have an ill-defined sense ofepigastric discomfort and an associated sense of

fullness that is often caused by large size of thetumor or episodic obstruction of digestive tract. (ifpedonculated)


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History

This obstruction may be partial early, which

progresses to complete obstruction as the tumor

grows larger. Vomiting


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History

Frank gastroduodenal intussusception secondary toprolapsing gastric tumors may occur.

obstruction


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Clinical Presentation History

The tumor may become huge exogastric tumors and

detected by the patient as a palpable mass.


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Physical Examination

Physical findings are not specific except for

underlying conditions such as Peutz-Jeghers

syndrome.

An abdominal mass may be palpable.

Palpation may elicit abdominal tenderness.


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Diagnosis Incidental discovery at the time oflaparotomy.

During the course ofbarium meal study.

Or during gastroscopy for a probably unrelated

disease is the most common method of detection.


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Lab Studies

Findings on laboratory serum tests arenonspecific.

Routine blood test (Anemia ?)

Routine stool test ?

Liver, spleen function tests ?

CAE (leiomyoma)?


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Imaging studies

Biopsy material ??

EndogastricIntramural

Sonography

For examination of the gastric wall

CT scan?

ECG?


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NEXT


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Lymphoma of the stomach

Background

The second most common primary cancer of the

stomach but constitute only 2-5% of the total

number, 95% being adenocarcinomas. (almost all arenon-Hodgkin's lymphoma, and generally classified as B cell mucosa-

associated lymphoid tissue (MALT)) lymphoma. About 20% of patientsmanifest a second primary cancer in another organ. Also classified as low

grad or high-grade base on nuclear pattern.)

Macroscopically: infiltrative, ulcerative, nodular, polypoid, and combines


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Background

There are many different non-Hodgkin'slymphoma (NHL).

Low-grade NHL

High-grade NHL Cutaneous T cell lymphoma (rare, it is mycosis

fungoides, lymphoma that affects the skin)


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Low-grade NHL

May be

Large or smallGrouped together (follicular type)

Spread out (diffuse type)


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Low-grade NHL

Small cell lymphocytic Follicular

Mantle cell

Splenic marginal zone lymphoma

MALT lymphoma

Lymphoplasmacytic NHL (also called

Waldenstrom's macroglobulinaemia)


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High grade NHL

Diffuse large B cell

Diffuse mixed cell lymphoma

Burkitt lymphoma Anaplastic large cell lymphoma

Diffuse mixed cell lymphoma


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Transforming from low grade to high grade Over time, low grade lymphomas may change into a

more aggressive high grade type lymphoma. If itdoes, it may be several years after you were first

diagnosed with the low grade lymphoma. higher grade type poorer prognostic


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Clinical presentation History

Patients with primary gastric lymphoma are usually in

their mid-fifties, with a male-to-female predominance

of 1.7 to 1.

Less than 20% of patients present asymptomatically.


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Clinical presentation

History

Pain:

The major symptom, occurring in over 80% of

patients, and it may be associated with: anorexia

early satiety

nausea

and vomiting.


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History

Vague symptoms

Such as

Weakness

Malaise are also relatively common.


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History

Remember In case of diffuse lymphoma

night sweats

weight loss fever

Can be present in up to 40%.

f


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History Remember:

42% ofPatients presented with emergency

complication of gastrointestinal lymphoma: Bleeding

Perforation

Obstruction

Fistula


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Physical Examination Patients with primary gastric lymphoma sometimes

present with abdominal findings suggestive of a mass

in the left upper quadrant.

Most commonly there are no abdominal findings

unless there is a complication of the tumor.


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Splenomegaly is occasionally found in patients

with direct extension of the lymphoma to the

spleen.

Massive splenomegaly may indicate diffuse

lymphoma.


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Other findings that suggest diffuse or abdominal

lymphoma include: palpable peripheral adenopathy

or large retroperitoneal mass.


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Diagnosis

Upper Gastrointestinal Radiology

Ultrasonography

CT scan

Gastrointestinal endoscopy


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Treatment

Medical (Helicobacter pylori)

According to the stage

Surgery

Chemotherapy

Radiation therapy


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benign tumors of the stomach

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