Tumors of the stomach and duodenum.ppt

Tumors of the stomach  and duodenum INTRODUCTION - STOMACH Benign Polyps Hyperplastic Fundic gland Neoplastic Multiple Tumors Leiomyomas Lipomas Heterotopic pancreas Malignant Tumors Carcinoma Lymphoma Sarcoma Carcinoid Others Menetriers Disease Bezoar Volvulus GASTRIC POLYPS Hyperplastic polyps Most common type of polyp (65 – 90%) Inflammatory or regenerative polyps In reaction to chronic inflammation or regenerative hyperplasia Often found in HP infections Sessile and seldom pedunculated Mostly in the antrum Multiple in 50% of cases Varying in size but seldom 2cm Rate of malignant transformation 1 – 3% Usually larger than 2 cm GASTRIC POLYPS Fundic Gland Small elisions in the fundus Hyperplasia of the normal fundic glands Often associated with FAP Therefore important as a marker for disease elsewhere in the GIT tract GASTRIC POLYPS Neoplastic polyps Types Tubular Villous (often larger - 2cm - and malignant) Macroscopically More often in antrum Pedunculated with malignant potential Solitary, large and ulcerated Treatment Endoscopic removal if no malignancy identified with surveillance Excision with malignant focus or where endoscopic removal failed GASTRIC POLYPS Multiple gastric polyps Rare condition Adenomatous and hyperplastic polyps 20% incidence f adenocarcinoma Treatment If confined to corpus and antrum – distal gastrectomy Otherwise total gastrectomy Sometimes associated with Polyposis syndromes FAP Gardner Peutz-Jeghers Cowden Cronkhite Canada GASTRIC LEIOMYOMA Incidence of 16% at autopsy Pathology Arise from smooth muscle of the GIT tract Difficult to distinguish from GIST 75% benign Differentiation only on mitotic index Large protruding elisions with central ulcer Usually presents with bleeding if at all Treatment is local excision with 2 – 3cm margin GASTRIC LIPOMA Rare subcutaneous lesions Asymptomatic On routine endoscopy Require no treatment Pillow sign HETEROTOPIC  PANCREAS Ectopic pancreas Most common found in stomach Within 6 cm from the