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Benign and malign diseases of Stomach

Benign and malign diseases of Stomach. Prof. Dr. Öge TAŞCILAR. Esophagus/Stomach Junction. Esophagus : stratified squamous non-keratinized epithelium. Stomach : Simple columnar epithelium. MİDE. Mukoza Submukoza Muskularis Propria Seroza Mukoza İntraepitelyal Mukoza Epitel

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Benign and malign diseases of Stomach

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  1. Benignandmaligndiseases of Stomach Prof. Dr. Öge TAŞCILAR

  2. Esophagus/Stomach Junction Esophagus: stratified squamous non-keratinized epithelium Stomach: Simple columnar epithelium

  3. MİDE • Mukoza • Submukoza • MuskularisPropria • Seroza • Mukoza İntraepitelyal Mukoza Epitel Bazal Membran LaminaPropria Muskularis Mukoza

  4. MİDE • Fonksiyon: • Alınan gıdaların sindirimi ve emilimi • Reseptifrelaksasyon ve gastrik adaptasyon • İntragastrik basınç düşer. • 100cc-------------1500cc

  5. MİDE • Mallory-Weiss Sendromu • Kusma ÖG bileşke • Mukoza submukoza yırtık ve kanama • Endoskopi • Alkol,diyabet,gebelik, üremi, • Tam kat olursa Booerhaave sendromu

  6. MİDE • Bezoarlar • Midede oluşan yabancı cisimler. • Trikobezoar-fitobezoar • Mide operasyonu sonrası • Antrumun öğütücü işlevinin kaybolması • HCL azalmasına bağlı Candida Albicans bezoar • Tanı: Radyoloji-endoskopi • Tedavi:Endoskopik-Cerrahi

  7. MİDE • Menetrier Hastalığı • Hipertrofikmukozalgastropati • Fundus ve korpusta dev rugalar • Foveolarhiperplazi • Hipoklorhidri ve Hipoalbüminemi • 50> erkekler • Epigastrik ağrı, kilo kaybı, (özellikle protein) , kanama, diare, ödem • Medikal tedavi PPI • Destek tedavisi • Çok ciddi olgularda rezeksiyon

  8. Gastritis • Acute gastritis often due to chemical injury (alcohol drugs)

  9. Acute gastritis • Drugs (non-steroidal anti-inflammatory drugs NSAID), alcohol cause acute erosion (loss of mucosa superficial to muscularis mucosae). Can result in severe haemorrhage

  10. Chronic gastritis ABC • A – autoimmune(associated with vitamin B12 malabsorption (pernicious anaemia) • B – bacterial (helicobacter) • C – chemical(bile reflux, drugs)

  11. Autoimmune chronic gastritis • Autoantibodies to gastric parietal cells • Hypochlorhydria/achlorhydria • Loss of gastric intrinsic factor leads to malabsorption of vitamin B12 with macrocytic,megaloblastic anaemia

  12. Helicobacter pylori • Adapted to live in association with surface epithelium beneath mucus barrier • Causes cell damage and inflammatory cell infiltration • In most countries the majority of adults are infected

  13. Chemical gastritis • Commonly seen with bile reflux (toxic to cells) • Prominent hyperplastic response (inflammatory cells scanty) • With time – intestinal metaplasia

  14. Peptic ulcer disease • A surface breach of mucosal lining of GI tract occurring as a result of acid and pepsin attack • Sites: • Duodenum (DU) • Stomach (GU) • Oesophagus • Gastro-enterostomy stoma • Related to ectopic gastric mucosa (e.g. in Meckel’s diverticulum)

  15. Chronic peptic ulcer • Complex epidemiology • DU most common in Europe, GU in Japan • Incidence of DU declining, GU stable

  16. Pathogenesis • In normal acid/pepsin attack is balanced by mucosal defences • Increased attack by hyperacidity • Weakened mucosal defence – the major factor (H. pylori related)

  17. MİDE • DU son yıllarda azalmaktadır. • Sigara azalması • HP etkin korunma • H2 blokör, PPI • Mukoza saldırgan faktörler etkili • HP, NSAİ, ZES

  18. MİDE • Duodenal Ülser: • Duodenal HCO3 sekresyonu azalmış • Gece asit sekres. Artmış • Duodenal asit yükü atmış • Bazal ve postbrandial gastrin artmış • PH kitlesi artmış. • Tamamına yakın HP gastrit saptanmıştır.

  19. Morphology of peptic ulcers • Clean, non-elevated edge • Granulation tissue base (floor) • Underlying fibrosis

  20. MİDE • Klinik: • Yanıcı, kemirici, açlık ağrısı. • Epigastrium • Antiasit ve gıda ile hafifler. • Mevsimsel bir ağrı. • İlkbahar, sonbahar, stress dönemleri • Penetre olursa ağrı özellikleri değişir.

  21. MİDE • Anamnez, • Radyoloji • Endoskopi, biyopsi • Tedavi: • Medikal tedavi Antiasit Sükralfat H2 blokör PPI Prostoglandin analogları

  22. MİDE • DÜ Cerrahi Tedavi: • BTV-PP • BTV-Distal gastrektomi+GJ • PGV

  23. MİDE • Mide Ülseri • MÜ 5 tip vardır. • Tip 1: En sık %60. Küçük kurvatur. • Tip 2:%20-25 Duodenuma yakın(Kombine gastrik, duodenal) • Tip 3: %20. Prepilorik antrum • Tip 4: GÖ bileşkeye yakın • Tip 5: Diffüz Alkol, NSAİ

  24. Benign gastric ulcer (B)

  25. MİDE • Mide Ülseri • MÜ Cerrahi tedavi: • Tip 2-3 duodenal ülser gibi tedavi • Tip1: Ülseri içine alan distal gastrektomi+GJ

  26. Complications of peptic ulcer • Perforation leading to peritonitis • Haemorrhage by erosion of vessel in base • Penetration of surrounding organ (liver/pancreas) • Obstruction (by scarring) – pyloric stenosis • (Cancer – rare event in true peptic ulcer)

  27. Complications of peptic ulcer • Kanama: • DÜ kanama • Kanayan yere transfiksiyon+BTV+PP • Genç veya kronik olgularda: • Kanayan yere transfiksiyon+ Ülseri içeren antrektomi+BTV

  28. Complications of peptic ulcer • Kanama: • MÜ kanama: • Tip1: Ülseri içine alan distal gastrektomi+GJ • Tip 2-3: DÜ kanamasındaki aynı tedavi

  29. Complications of peptic ulcer • Delinme • DÜ • Graham usulü Duodenorafi+PPI • Graham usulü Duodenorafi+ PGV

  30. Complications of peptic ulcer • Delinme • MÜ • Tip1: Ülseri içine alan distalgastrektomi+GJ veya omentalpatch. • Tip 2: BTV+Antrektomi • Tip 3: BTV+Antrektomi

  31. NEOPLASMS OF STOMACH BENIGN__ 10% MALIGNANT__90% BENIGN Polyps Lipomas Leiomyomas

  32. NEOPLASMS OF STOMACH MALIGNANT Adenocarcinoma95% Lymphoma4% Others1% (sq.cellca, angiosarcoma,carcinosarcoma, Gist)

  33. Less common gastric neoplasms • Gastrointestinal stromal tumour (GIST) • Lymphoma • Neuroendocrine (carcinoid) tumours

  34. Gastrointestinal stromal tumours (GIST) • Mesenchymal neoplasms • Derived from interstitial cells of Cajal (pacemaker cells controlling peristalsis) • Overexpress c-kit oncogene • Used as diagnostic aid on tissue • A target for therapy with tyrosine kinase inhibitor imatinib (also used in CML)

  35. GIST-spindle cell neoplasm of GI tract

  36. GIST • Larger tumours with high mitotic rate tend to behave malignantly • Stomach is commonest site

  37. GIST • Risk categories were assigned according to current recommended NIH criteria. • Tumors <2 cm and<5 mitosis per 50 high-power fields (HPF) were classified as very low risk. • Tumors ranging from 2 to 5 cm and having <5 mitoses/50 HPF were classified as low risk.

  38. Tumors <5 cm but having 6 to 10 mitoses/50 HPF were intermediate risk, as were tumors from 5 to 10 cm with <5 mitoses/50 HPF. • Tumors >5 cm with >5 mitoses/50 HPF was defined as high risk, as was any tumor >10 cm or any tumor with >10 mitoses/50 HPF.

  39. GASTRIC STROMAL TUMOURS PRESENTATION; Mass abdomen Upper GI bleeding Obstruction PATHOLOGY; Difficult to ascertain benign or malignant nature Size & Histology is the criteria TREATMENT; Surgical resection Lymph node resection not necessary.

  40. MİDE LENFOMA • NHL klasik olarak lenf nodlarından gelişir. • Ama NHL %30 olguda ekstranodal(Solid organ kaynaklı) olarak gelişebilir. • GI sistem tüm NHL %20

  41. MİDE LENFOMA • GI lenfoma; oral kaviteden rektuma • En sık; Mide • Sonra ince barsak • Kolon • Pankreas

  42. MİDE LENFOMA • NHL, ekstranodal lenfoma ve GI lenfomanın en sık görülen tipi diffüz B hücre lenfoması. • MALT lenfoma • Burkitt lenfoma • T- hücre lenfoma

  43. Gastric lymphoma • Malignant neoplasm of mucosa associated lymphoid tissue (MALT) • A (usually) low grade B-cell (marginal cell) lymphoma

  44. MİDE LENFOMA • GASTRİK LENFOMA • DLBCL (%55)ve MALT tipi lenfoma(40), %3 BurkittLenfoma • Antrum ve distal mide • Proksimal yerleşebilir. • Karın ağrısı, erken doyma • Bulantı, kusma, halsizlik • Abdominal dolgunluk • Kronik kan kaybı, anemi melena

  45. Gastric lymphoma (maltoma) • Neoplastic cells infiltrate the epithelium (lymphoepithelial lesions) • Strongly associated with chronic H. pylori and can be cured by eliminating infection.

  46. MİDE LENFOMA • Ann Arbor Musshoff Modifikasyonu: • IE: Diyafragmanın bir tarafında bir organda veya tek lenf nodu bölgesi • IE1: Mukoza-submukoza • IE2: Muskularis invaze

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