GI Section 1: Luminal (Gastric Tumors) Flashcards
This is the most common mesenchymal tumor of the GI tract
GIST (Gastrointestinal Stromal Tumor)
(70% in stomach, duodenum is second most common — colon is actually the least common)
These can be benign or malignant
What favors a benign GIST over a malignant GIST?
Lymph node enlargement is NOT a classic feature
Absence o fperigastric lymphadenopathyfavors a benign GIST over a malignant GIST or Gastric Adenocarcinoma
Malignant GIST features
> 5 cm with ulceration - possible perforation
Where to GIST mets?
Liver
GIST is associated with what conditions?
Carney’s triad and NF-1
Carneys Triad (“Carney’s Eat Garbage”)
Chondroma (pulmonary)
Extra adrenal Pheochomocytoma
GIST
Gastric CA is either?
A lymphoma (<5%)
or
AdenoCA (95%)
Rarely a malignant GIST
Old (median, rare before 40)
+ Hx of H.Pylori
Gastric AdenoCA
Gastric AdenoCA
Can obstruct (if it involves the antrum)
Gastric AdenoCA mets to ovary =
Krukenberg Tumor
Remnant of Gastroenterostomy in Gastric adenoCA?
“stump CA”
Risks of Gastric AdenoCA
Pernicious anemia
Menetrier’s disease (giant mucosal folds in the proximal part of the stomach, diminished acid secretion, and a protein-losing state with hypoalbuminemia.)
Swollen left supraclaviculare node =
Virchow node
smoothly marginated and exophytic
GIST
a large, ulcerated, heterogenous mass.
Gastric Adeno CA
Describe the mass iin adenoCA?
The “mass” is often asymmetric wall thickening - focal and nodular - more than
12mm.
Types of Gastric Lymphoma
Primary - MALT (mucosa-assisted lymphoid tissue)
or
Secondary (Systemic Lymphoma)
Most common Extranodal site for NHL
The stomach
H.pylori is a risk factor for these diseases
AdenoCA and Lymphoma
Rarely causes gastric outlet obstruction, even when extensive
Gastric Lymphoma
“crossing the pylorus ”
Gastric lymphoma
Lymphoma - crossing the pylorus
Classic Look =
Diffiise wall thickening (>1 cm) * Without gastric outlet obstruction
What can happen to Gastric lymphoma after chemo?
Can rupture
Gastric Cancer is “More Likely” Than Lymphoma to…
More Likely to:
- Cause Gastric Outlet Obstruction
- to be in the distal stomach
- to extend beyond the serosa and obliterate adjacent fat plains
- to be a focal mass (95% of primary gastric tumors are adenocarcinoma)
Although very rare, mets to the stomach is most commonly caused by this culprit, then the following
Melanoma
then breast (most classic) and lung
multiple button type soft tissue nodules
Metastatic Melanoma
Linitis plastica - can also be a look for lymphoma
diffuse infiltration and a contracted desmoplastic deformity resembling a stiff leather bottle.
Caused by metastatic breast (lobular CA) and lung CA
