BENIGN DISORDERS OF STOMACH

BY
Dr.Firdosh A.Dekhaiya (M.S.) Assistant professor, Surgery Govt.Medical college,Bhavnagar.

TUMOURS

EPITHELIAL POLYPS 
Hyperpastic Adenomatous

MESENCHYMAL TUMOURS 
Leiomyoma Fibroma Neurogenic -Schwannoma -Neurofibroma Lipoma Vascular Osteroma and Osteochondroma

MISCELLANEOUS TUMOURS 
Heterotopic pancreas Inflammatory pseudotumours Hemartomatous in Peutz-Jeghers polyp Cyst

or gastric outlet obstruction. Occassionally they present as pain. .bleeding. The only cause of concern is that some of them have POTENTIAL FOR MALIGNANT TRANSFORMATION.Benign tumours of stomach are RARE and found incidentally on endoscopically or in postmortem examination. Majority of them are EPITHELIAL TUMOURS(75%).

 5 times as commoon as adenomatous.  No potential for malignancy .  May undergo spontaneous regression.HYPERPLASTIC POLYPS  Distributed throughout stomach  Multiple  <2 cm in diameter.

 >2 cm diameter usually.ADENOMATOUS POLYPS  Most commonly seen in antrum  Usually SINGLE.  When so.nearly 33-50% of these tumours will become malignant. .

.MESENCHYMAL TUMOURS  1/8th of all gastric neoplasms  Leiomyomas are commonest.hence described together.  All variety are very similar in appearance and behaviour.

.MESENCHYMAL TUMOURS  Usually single  Located in submucosa.  Location:antrum  Leiomyomas and fibromas can also be found near gastro oesophageal junction.  Rounded sessile or pedunculated masses  Ulceration with bleeding commonly seen.  Size varies from a few mm to many cms.

MESENCHYMAL TUMOURS  Degeneration: -cystic changes -myxoid degeneration -calcification -ossification  Malignant transformation occurs in vascular and untreated tumours. .

MESENCHYMAL TUMOURS PRESENTING SYMPTOMS  Mostly asymptomatic but may present as:  Malena  Anemia  Dyspepsia  Gastric outlet obstruction (due to prolapsed growth through pylorus)  In elderly-palpable abdominal mass .

 All pancreatic pathologies affect them.  May have umbilicated appearance(a central ductal orifice).  Discrete.rubbery lesions.upto 3 cm dia.HETEROTOPIC PANCREAS  Usually found in antrum or prepyloric region. .

INFLAMMATORY PSEUDOTUMOURS Also known as-  Inflammatory fibroid polyps  Eosinophilic granulomas  Eosinophilic gastritis  Gastric submucosal granulomas with eosinophilic infiltration .

 Mimic malignancy. .  Histology:inflammation with connective tissue and vascular proliferation with predominantly eosinophilic cell infiltrate.INFLAMMATORY PSEUDOTUMOURS  Present as polypoidal or infiltrative lesions  Many cms large  Mostly ulcerated.

.and may be found occassionally in the stomach.PEUTZ-JEGHER¶S POLYPS  These are monmalignant malformations or hemartomas that represent focal overgrowth.  Whether they are precancerous or not is not known.

CYSTIC TUMOURS  Very rare.infective.posttraumatic or neoplastic lesions.  A heterogenous group of developmental anomalies. .

MENETRIER¶S DISEASE (Hypertrophic gastritis) .

 Later the epithelium assumes the appearance of large. .MENETRIER¶S DISEASE (Hypertrophic gastritis)  A rare inflammatory disease of the gastric epithelium characterized by hypertrophic gastric folds within the proximal stomach.polypoid overgrowths.multiple.

MENETRIER¶S DISEASE (Hypertrophic gastritis)  Histology:Thickened folds consist of hypertrophy of the gastric glandular epithelium+increase in size of submucosa. of round cells(Hence a hypothesis of autoimmune aetiology). .which is oedematous and contains a large no.

MENETRIER¶S DISEASE (Hypertrophic gastritis)  Clinically :massive loss of plasma proteins from gastric epithelium that is normally impermeable to large molecules. .

BEZOARS 13/08/2009 13/08/2009 .

 Examples: -Trichobezoars -Phytobezoars -Pharmacobezoars .BEZOARS  Bezoars are concretions of indigestible matter that accumulates in the stomach.

DIEULAFOY¶S LESION  A gastric arterial venous malformation that has a characteristic histological appearance.this lesion may be invisible.  When bleeds it appears as profuse bleeding coming out from normal mucosa. .  When not bleeding.

.GASTRIC DIVERTICULA  Rare lesions.  Common age of presentation:20-60  Common site: Posterior cardia and body  Complications:rare but haemorrhage and infection can occur.  Consist of all 3 layers  Usually congenital.

MALLORY-WEISS TEARS  Lacerations in the region of G-E junction that can follow episodes of vomitting & retching. .  Often associated with heavy alcohol consumption and may produce excessive GI bleeding.  Self limiting in 80-90% of pts.

and it is unable to pass a Ryle¶s tube. .  Presents as sudden severe epigastric pain and unability to vomit.GASTRIC VOLVULUS  Torsion or twist  Typically occurs along the long axis of the stomach(organoaxial) in association with paraoesophageal hernias so that in contrast studies stomach appears upside down.

FOREIGN BODIES .

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