to have knowledge on malignancies other than adenocarcinoma in stomach

1. OTHER NEOPLASMSOTHER NEOPLASMS
OF STOMACHOF STOMACH
By
Dr.R.Vinoth Prabu 1
Prof Dr.S.R.Dhamotharan MS
IV Surgical unit
Assistants:
Dr Shanthi Nirmala MS
Dr Celine Foustina Mary MS
Dr Arulraj Kumar MS

2. Constitutes 10%
• Lymphoma 3-4%
• Mesenchymal tumors
– GIST 1-2%
– leiomyosarcoma 1%
others 1%
• Endocrine tumors 1%
– Carcinoid - commonest
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3. 3
LYMPHOMA

4. • Stomach – MC site of primary GI
Lymphoma(95% NHL)
• Sixth to seventh decades
• Most common Bcell type(MALT)
Next DLBCL
• H.Pylori
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55-65%
20-35%
7-20%

5. What is MALT?
– Extranodal
marginal zone
lymphoma of
mucosa-associated
lymphoid tissue
(MALT)
– Heterogeneous,
predominantly
small B-
lymphocytes 5Lymphoepithelial lesions

6. Diagnosis
 Barium study
 CTscan
 Endoscopy
 Endoscopic ultrasound
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7. 7
1 2Endoscopy

8. Dawson’s criteria
• No palpable superficial lymphadenopathy
• No mediastinal involvement on CXR
• Normal Total &Diff. Count
• At surgery
– disease limited to dominant bowel lesion and adjacent
nodes
– No liverorspleen involvement
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9. 9

10. MALT
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11. • RCHOP
• RT
• Both
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DLBCL

12. 12
GIST

13. • Distinct group of mesenchymal tumors recognized after
1990 with IHC
• Adults
• M>F
• Small asymptomatic GISTs are found at autopsy in more
than 50 % of individuals overthe age of 50
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14. GISTs are identified by
 eitherc-kit immunoreactivity (detection of the CD117 antigen)
orthe presence of activating mutations in kit orPDGFRA
 cell of origin
– interstitial cells of cajal
– c.kit proto oncogene is responsible fordevelopment of
tumor
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15. Cellular Morphology
• Three relatively distinctive types
 Spindle cell type – 70 percent
 Epithelioid type – 20 percent, more commonly c-kit negative
and found in omentum and mesentery
 Mixed type – 10 percent.

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16. Histopathology
• Differential Diagnosis
• H&Estain: Melanoma, leiomyoma/sarcoma,
peripheral nerve sheath tumor, desmoid
• Histology difficult
• Immunophenotyping crucial
 95 % are positive forC-kit (CD117)
 60-70 % positive forCD34
• Negative foralpha-smooth muscle actin
(SMA) (leiomyoma)
• Negative forS100 protein (Schwannoma)
• Negative forDesmin (desmoids)
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17. Determinants of Malignant BehaviorDeterminants of Malignant Behavior
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18. Metastasis
GISTs behave differently than othersoft tissue sarcomas:
• GISTs frequently metastasize to the liverand rarely
to regional lymph nodes
• GISTs virtually nevermetastasize to lungs whereas
this is the most common site of metastasis for
leiomyosarcomas
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19. Clinical Manifestations
• Mesenchymal tumors of the GItract are often asymptomatic and
discovered incidentally during endoscopic orbarium studies.
• Overt GIbleeding — 40 percent
• Abdominal mass — 40 percent
• Abdominal pain — 20 percent
• The vast majority of GISTmetastases at presentation are intra-
abdominal, eitherwith metastases to the liver, omentum, or
peritoneal cavity .
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20. Investigations
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CT Scan
EndoscopySpecimen

21. 21
EUS

22. Imatinib (Gleevec) a Tyrosine Kinase
Inhibitor
• Imatinib mesylate is a protein-
tyrosine kinase inhibitorthat
inhibits the Bcr-Abl tyrosine
kinase.
• Thyrosine kinase inhibtor
effective in metastatic and
unresectable disease.
• Shows > 50% regression.
• Duration of therapy not yet
known. 22

23. 23
Management

24. 24

25. Progressive disease
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26. TUMOR ARISING FROM LESSER CURVATURE STOMACHTUMOR ARISING FROM LESSER CURVATURE STOMACH
AND GROWING INTO LESSER OMENTUMAND GROWING INTO LESSER OMENTUM
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27. TUMOR ISOLATED AND FREE MARGIN AFTER EXCISIONTUMOR ISOLATED AND FREE MARGIN AFTER EXCISION
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28. 28
CARCINOID

29. • Composed of argyrophlic ECLcells
• 8% of all GICarcinoids
• Pernicious anemia and atropic gastritis
• 5% will produce carcinoid syndromes
• Carcinoid tumors of stomach produce atypical symptoms
orasymptomatic
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30. 30
Endoscopy

31. 31

32. 32

33. Endoscopic Ultrasound
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34. 34

35. 35
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36. THANKTHANK YOUYOU
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