pathology of tumors of stomach

1. TUMORS OF
STOMACH

2. • Tumors can be BENIGN or MALIGNANT
• Benign tumors of stomach are:
1. Adenomas
2. Stromal tumors
• Malignant tumors are:
1. Gastric carcinoma
2. Leiomyosarcoma
3. Leiomyoblastoma
4. Carcinoid tumors
5. Lymphomas of gut

3. BENIGN TUMORS:
• ADENOMAS:
o Also called as adenomatous or neoplastic polyps.
o Epithelial neoplasms
o Rare in stomach but common in large intestine
o Associated with atrophic gastritis and pernicious
anaemia
• STROMAL TUMORS:
o Commonly found stromal tumors are – leiomyomas,
neurofibromas, schwannomas, lipomas.
o Firm, circumscribed nodules, <4cm = dm, and appear
as submucosal nodules.

4. Adenoma

5. Stromal tumor

6. MALIGNANT TUMORS:
A. GASTRIC CARCINOMA:
o Very common
o 40 – 60 years
o 2 times common in men than women
Etiology :
1. H.pylori infection
2. Dietary factors
3. Geographical factors
4. Racial factors
5. Genetic factors
6. Pre-malignant changes in gastric carcinoma

7. Pathogenesis:
1. H.pylori infection:
H pylori
infection
Chronic
inflammation
Ulceration of
gastric mucosa
Extensive effects
of cytokines
Gastric
carcinoma

8. 2. Dietary factors: common foods associated with
carcinoma of stomach are smoked foods, high intake
of salts, pickled raw vegetables, nitrates as
preservatives and in drinking water and food, tobacco
smoke, tobacco juice and alcohol.
foods
Extensive irritation of
gastric mucosa along lesser
curvature of the stomach
Gastric carcinoma

9. 3. Geographical factors:
Very common in Japan, Italy, Chile.
Less common in US, UK, Canada
4. Racial factors:
Common in Blacks, Chinese, North Whales than any
other parts of the country.
5. Genetic factors:
Common in people with family history and blood
group A

10. 6. Premalignant conditions :
a) Hypo- or achlorhydria in atrophic gastritis of gastric
mucosa with intestinal metaplasia
b) Adenomatous (neoplastic) polyps of the stomach
c) Chronic gastric ulcer
d) In patients who have undergone partial
gastrectomy.

11. Morphological features:
• G/A :
o Commonly present in prepyloric region, formed by
lesser curvature, pylorus and antrum.
o Less common parts are cardia, fundus and body.
o Classification based on the situation:
1. Early gastric carcinoma
2. Advanced gastric carcinoma : it is further divided into:
a) Ulcerative carcinoma
b) Fungating (polypoid) carcinoma
c) Scirrhous carcinoma (Linitis plastica)
d) Colloid (mucoid) carcinoma
e) Ulcer - cancer

12. EARLY GASTRIC CARCINOMA:
• Limited to mucosa and submucosal layer.
• G/A:Has 3 patterns:
1. Polypoid (protruded)
2. Superficial
3. Ulcerated
• M/E:
1. well differentiated tumor
2. Glandular adenocarcinoma

15.  ADVANCED GASTRIC CARCINOMA:
1. Ulcerative carcinoma:
• Most common pattern
• Flat, infiltrating and ulcerative growth with irregular
necrotic base and raised margin
• Commonly present in gastric canal
• M/E:
o poorly differentiated
o Invades deep into muscular layer
o Common patterns are tubular and acinar

18. 2. Fungating Carcinoma :
• Cauliflower growth fungating into the lumen of the
stomach
• Commonly present in fundus
• Undergoes necrosis and infections
• M/E:
o Well differentiated
o Papillary type

21. 3. Scirrhous carcinoma:
• Extensive desmoplasia causes thickening of the
stomach
• May involve only pyloric antrum / whole stomach
• The lumen of stomach is reduced.
• M/E:
o Can be adenocarcinoma / stignet – ring cell
carcinoma
o Extensive infiltration of the cells.

24. 4. Colloid carcinoma:
• Usually seen in the fundus.
• The tumor grows like masses having gelatinous
appearance due to excessive secretion of mucus.
• M/E:
o Abundant secretion of mucin in which there is
tumor cells having stignet ring cell appearance.

27. 5. Ulcer cancer:
• Development from chronic ulcer.
• Malignant from the beginning
• M/E:
o Adenocarcinoma in nature.

30.  Spread :
1. Direct spread
2. Lymphatic spread
3. Haematogenous spread
 Clinical features :
1. Persistent abdominal pain
2. Gastric distention and vomiting
3. Cachexia
4. Anorexia
5. Weight loss, malaise and weakness
6. Haemorrhage
7. Obstruction
8. Perforation
9. Jaundice

31. B. LEIOMYOSARCOMA:
• Rare
• Soft tissue carcinoma
C. LEIOMYOBLASTOMA / EPITHELOID LEIOMYOMA :
• Rare
• Intermediate between benign and malignant tumors
D. CARCINOID TUMOR:
E. LYMPHOMAS OF GUT :
1. Primary gastrointestinal lymphoma
2. Secondary gastrointestinal lymphoma