Benign Tumors of The Stomach

BENIGN TUMORS OF THE STOMACH
BACKGROUND
Approximately 7% of premortem gastric tumor are
benign.
A recent series of 5554 patients undergoing upper

gastrointestinal endoscopy suggested an incidence of
0.8% of the total population screened.
• 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 true gastric

neoplasms found at the time of autopsy.
►Approximately 3% of those discovered at the time of

endoscopy in symptomatic patients.
• BACKGROUND
• Approximately 40% of these tumor are ►mucosal
epithelial polyps, another 40% are ►leiomyomas.
• And all the remaining types are rare.

• Polyps
• Polyp is generally used to describe any growth that
protrudes into the gastric lumen.
• Almost all gastric polyps arise from the mucosal

epithelium.
• Polyps
• The nomenclature of gastric polyps is confusing largely
because of early attempts to present them as being
analogous to colorectal polyps in microscopic
appearance and natural history.
• 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.
• 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 to

several centimeters.
• 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 gastristis polyposis cystica.

• 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.
• 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 FAP patients)
• Polyps
• Inflammatory fibroid polyps
Also known as eosinophilic granuloma,

granulomablastoma, neurofibroma, and
hemangiopericytoma.
• Gastric polyps in polyposis syndromes

• Gastric involvement occurs in over 50% of
patients with familial polyposis coli (FAP) and
related Gardner’ syndrome.
• Intramural Tumors
• Leiomyomas
• Are the most common benign tumor of the stomach reported at autopsy.
• There is a spectrum from benign to malignant.
• The only reliable indicator of malignancy in these and other GISTs is evidence
of extragastric spread
• Intramural Tumors
• Leiomyomas
• These tumors can cause symptoms by obstruction,
ulceration, and blood loss or by compressing adjacent
organs.
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.
• Brunner’s Gland Adenoma.

• Brunner’s gland adenoma can occur in the
antrum or juxtapyloric region, representing
heterotopic locations of a hamartomatous lesion
that is usually found in the duodenum.
• 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
• Menetrier’s Disease
• Is characterized by gastric mucosal hypertrophy
that may be so extensive that the rugae assume the
appearance of convolutions of the brain.
• Pseudolymphoma
• This is extensive lymphocytic infiltration of a portion
of the stomach, Generally associated with a benign
gastric ulcer.
• Cystic tumors
• Cystic tumors can be mucocele or
intramucosal, and they are the most common
benign cystic lesion of the stomach.
• 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.

• History
• Complaints may be:
• Pain
• Indigestion
• Obstruction (vomiting)
• Weight loss
• or unexplained anemia (occult blood
loss??)
• History
• Because of the propensity of these tumors to
ulcerate the associated mucosal epithelium, the
resultant occult blood loss can cause iron-deficiency
►►anemia.
• 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.
• History
• Patients may therefore have an ill-defined sense of
epigastric discomfort and an associated sense of
fullness ►that is often caused by large size of the
tumor or episodic obstruction of digestive tract. (if
pedonculated)
• History
This obstruction may be partial early, which progresses to
complete obstruction as the tumor grows larger. ►►
Vomiting
• History
• Frank gastroduodenal intussusception secondary to
prolapsing gastric tumors may occur. ►►
obstruction
• History
• The tumor may become huge exogastric tumors and
detected by the patient as a palpable mass.
• 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.

Diagnosis
► Incidental discovery at the time of laparotomy.
► During the course of barium meal study.
► Or during gastroscopy for a probably unrelated

disease is the most common method of detection.
• Lab Studies
• ►♂ Findings on laboratory serum tests are nonspecific.
• Routine blood test (Anemia ?)

• Routine stool test ?
• Liver, spleen function tests ?
• CAE (leiomyoma)?
Imaging studies
Biopsy material ??
Endogastric
Intramural
Sonography
For examination of the gastric wall
CT scan?
ECG?
• Treatment
• Surgery
• Endoscopy
• Celiotomy
• NEXT
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 are
non-Hodgkin's lymphoma, and generally classified as B cell mucosa-
associated lymphoid tissue (MALT)) lymphoma. About 20% of patients
manifest 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
Explications
• MALT lymphoma is a type of NHL that starts outside the lymphatic system.
MALT stands for mucosa-associated lymphoid tissue. It means that the
lymphoma begins to grow in lymphatic tissue that is found in the lining of
other organs
• MALT lymphoma is commonest in the stomach. It is linked to a
bacterial infection called helicobacter pylori. Research over the past
few years has discovered that treating the infection with antibiotics
can put MALT lymphoma of the stomach into remission. It is to
early to say how long the remission lasts. Treating the infection
may actually cure this rare type of NHL
• Background
• There are many different non-Hodgkin's
lymphoma (NHL).
► Low-grade NHL
► High-grade NHL
► Cutaneous T cell lymphoma (rare, it is mycosis
fungoides, lymphoma that affects the skin)
Low-grade NHL
May be
Large or small
Grouped together (follicular type)
Spread out (diffuse type)
• Low-grade NHL
• Small cell lymphocytic
• Follicular
• Mantle cell
• Splenic marginal zone lymphoma
• MALT lymphoma
• Lymphoplasmacytic NHL (also called
Waldenstrom's macroglobulinaemia)
• High grade NHL

• Diffuse large B cell
• Diffuse mixed cell lymphoma
• Burkitt lymphoma
• Anaplastic large cell lymphoma
• Diffuse mixed cell lymphoma
• Transforming from low grade to high grade

• Over time, low grade lymphomas may change into a
more aggressive high grade type lymphoma. If it
does, it may be several years after you were first
diagnosed with the low grade lymphoma.
►► higher grade type ►poorer prognostic
• Clinical presentation
• History
• Strikingly similar to that of adenocarcinoma of
the stomach making the diagnosis very difficult.
• 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.

• History
• Pain:
• The major symptom, occurring in over 80% of
patients, and it may be associated with: anorexia
• early satiety
• nausea
• and vomiting.
• History
• Vague symptoms
• Such as
• Weakness
• Malaise are also relatively common.
• History
• Remember
• In case of diffuse lymphoma ►►
• night sweats
• weight loss
• fever
• Can be present in up to 40%.
• History
• Remember:
• 42% of Patients presented with emergency
complication of gastrointestinal lymphoma:
• Bleeding
• Perforation
• Obstruction
• Fistula
• History
• Gastric lymphoma may also occurs following:
► surgical treatment for peptic ulcer
► treatment of Hodgkin's disease
► Chrohn’s disease
► or following immunosupression for renal
transplantation
• 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.
• Splenomegaly is occasionally found in patients
with direct extension of the lymphoma to the
spleen.
• Massive splenomegaly may indicate diffuse

lymphoma.
• Other findings that suggest diffuse or abdominal
lymphoma include:
• palpable peripheral adenopathy
• or large retroperitoneal mass.
• Diagnosis
• Upper Gastrointestinal Radiology
• Ultrasonography
• CT scan
• Gastrointestinal endoscopy
• Treatment
• Medical (Helicobacter pylori)
• ► According to the stage

• Surgery
• Chemotherapy
• Radiation therapy

Benign Tumors of The Stomach

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BENIGN TUMORS OF THE STOMACH

A recent series of 5554 patients undergoing upper

►Benign tumor constitute less than 2% of true gastric

►Approximately 3% of those discovered at the time of

• And all the remaining types are rare.

• Almost all gastric polyps arise from the mucosal

• Multiple polyps in the same patient are almost always

► They may vary in size from few millimeters to

• The gastric lesion termed polyadenomes polypeux corresponds to

• And cystic component referred to as gastristis polyposis cystica.

• They can be divided into adenomatous polyps

• Present as multiple small polypoid projections in the gastric fundus or body.

Also known as eosinophilic granuloma,

• Gastric polyps in polyposis syndromes

• There is a spectrum from benign to malignant.

• Presents clinically as a tumor and must be

• Brunner’s Gland Adenoma.

► Polyadenome en nappe (Menetrier disease)

• And are most commonly located in the gastric

• Tumor of the cardia and pylorus proper are rare.

• ►Deep ulcerations that overlie intramural tumors are

• ►Ulceration may cause syndrome indistinguishable from that

• Physical findings are not specific except for

• An abdominal mass may be palpable.

• Palpation may elicit abdominal tenderness.

► During the course of barium meal study.

► Or during gastroscopy for a probably unrelated

• Routine blood test (Anemia ?)

• High grade NHL

• Transforming from low grade to high grade

• Less than 20% of patients present asymptomatically.

• Most commonly there are no abdominal findings

• Massive splenomegaly may indicate diffuse

• ► According to the stage

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