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Understanding Benign and Malignant Diseases of the Stomach

Learn about the different conditions affecting the stomach, from gastritis to peptic ulcers, and their diagnosis and treatment options by Prof. Dr. Öge TAŞCILAR. Explore the pathology, causes, and complications of these stomach disorders.

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Understanding Benign and Malignant Diseases of the 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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