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BENIGNBENIGNDISORDERS OFDISORDERS OF

STOMACHSTOMACH

Dr.Firdosh A.Dekhaiya(M.S.)

Assistant professor,Surgery

Govt.Medical college,Bhavnagar.

BY

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TUMOURS

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EPITHELIAL POLYPSEPITHELIAL POLYPSHyperpasticAdenomatous

MESENCHYMAL TUMOURSMESENCHYMAL TUMOURSLeiomyomaFibromaNeurogenic

-Schwannoma-Neurofibroma

LipomaVascularOsteroma and Osteochondroma

MISCELLANEOUS TUMOURSMISCELLANEOUS TUMOURSHeterotopic pancreasInflammatory pseudotumoursHemartomatous in Peutz-Jeghers polypCyst

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Benign tumours of stomach are RARE and

found incidentally on endoscopically or inpostmortem examination.

Occassionally they present as

pain,bleeding,or gastric outlet obstruction.

The only cause of concern is that some ofthem have POTENTIAL FOR MALIGNANTTRANSFORMATION.

Majority of them are EPITHELIALTUMOURS(75%).

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HYPERPLASTIC POLYPS

Distributed throughout stomach

Multiple

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ADENOMATOUS POLYPS

Most commonly seen in antrum

Usually SINGLE.>2 cm diameter usually.

When so,nearly 33-50% of these tumours

will become malignant.

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MESENCHYMAL TUMOURS

1/8th of all gastric neoplasms

Leiomyomas are commonest.

All variety are very similar in appearanceand behaviour,hence described together.

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MESENCHYMAL TUMOURS

Usually single

Located in submucosa.

Rounded sessile or pedunculated masses

Ulceration with bleeding commonly seen.

Size varies from a few mm to many cms.

Location:antrum

Leiomyomas and fibromas can also befound near gastro oesophageal junction.

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MESENCHYMAL TUMOURS

Degeneration:

-cystic changes

-myxoid degeneration-calcification

-ossification

Malignant transformation occurs invascular and untreated tumours.

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MESENCHYMAL TUMOURS

PRESENTING SYMPTOMSMostly asymptomatic but may present as:

Malena

AnemiaDyspepsia

Gastric outlet obstruction (due to

prolapsed growth through pylorus)In elderly-palpable abdominal mass

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HETEROTOPIC PANCREAS

Usually found in antrum or prepyloricregion.

Discrete,rubbery lesions,upto 3 cm dia.May have umbilicated appearance(a

central ductal orifice).

All pancreatic pathologies affect them.

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INFLAMMATORY

PSEUDOTUMOURSAlso known as-

Inflammatory fibroid polypsEosinophilic granulomas

Eosinophilic gastritis

Gastric submucosal granulomas witheosinophilic infiltration

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INFLAMMATORY

PSEUDOTUMOURSPresent as polypoidal or infiltrative lesions

Many cms large

Mostly ulcerated.Histology:inflammation with connective

tissue and vascular proliferation with

predominantly eosinophilic cell infiltrate.Mimic malignancy.

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PEUTZ-JEGHERS POLYPS

These are monmalignant malformationsor hemartomas that represent focalovergrowth,and may be foundoccassionally in the stomach.

Whether they are precancerous or not isnot known.

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CYSTIC TUMOURS

Very rare.

A heterogenous group of developmentalanomalies,infective,posttraumatic or

neoplastic lesions.

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MENETRIERS DISEASE(Hypertrophic gastritis)

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MENETRIERS DISEASE

(Hypertrophic gastritis) A rare inflammatory disease of the gastric

epithelium characterized by hypertrophicgastric folds within the proximal stomach.

Later the epithelium assumes theappearance of large,multiple,polypoidovergrowths.

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MENETRIERS DISEASE

(Hypertrophic gastritis)

Histology:Thickened folds consist of

hypertrophy of the gastric glandularepithelium+increase in size ofsubmucosa,which is oedematous and

contains a large no. of round cells(Hence ahypothesis of autoimmune aetiology).

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MENETRIERS DISEASE

(Hypertrophic gastritis)

Clinically :massive loss of plasma proteinsfrom gastric epithelium that is normallyimpermeable to large molecules.

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BEZOARS

13/08/2009 13/08/2009

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BEZOARS

Bezoars are concretions of indigestiblematter that accumulates in the stomach.

Examples:

-Trichobezoars

-Phytobezoars

-Pharmacobezoars

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DIEULAFOYS LESION

A gastric arterial venous malformationthat has a characteristic histologicalappearance.

When not bleeding,this lesion may beinvisible.

When bleeds it appears as profusebleeding coming out from normal mucosa.

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GASTRIC DIVERTICULA

Rare lesions.

Consist of all 3 layers

Usually congenital.Common age of presentation:20-60

Common site: Posterior cardia and body

Complications:rare but haemorrhage andinfection can occur.

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GASTRIC VOLVULUS

Torsion or twist

Typically occurs along the long axis of thestomach(organoaxial) in association withparaoesophageal hernias so that incontrast studies stomach appears upsidedown.

Presents as sudden severe epigastric painand unability to vomit,and it is unable topass a Ryles tube.

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FOREIGN BODIES

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