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25 Cards in this Set
- Front
- Back
Classifications of Neoplasms
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Epithelial
-Benign = Adenomatous polyps -Malignant = Adenocarcinoma(90-95% of malig.) .Intestinal type .Diffuse type Non-epithelial -Benign = Leiomyoma -Malignant = GI stromal tumors(2% of malig.), Lymphoma(4-5% of malig.) |
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Gastric Leiomyoma
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Definition : benign smooth muscle tumor
Epidemiology : most common gastric tumor Gross Pathology : well circumscribed Histopathology : smooth muscle cells Complications : -Ulceration -Hemorrhage |
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Gastric Polyps definition
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Definition : focal protrusion of mucosa into lumen.
-2 types |
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Gastric Polyps types
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Non-neoplastic = Hyperplastic
-Occur following injury(e.g. ulcers) and are composed of aggregates of inflammatory cells and regenerating mucosal cells. - Common Neoplastic = Adenomatous = Adenoma -Benign proliferation of epithelium and stroma. -Malignant potential, but is not the precursor for most gastric adenocarcinoma (unlike colon) -Uncommon |
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new malignancies Gross patterns
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Infiltrating = diffuse = linitis plastica
linitis plastica (leather bottle stomach)-extensive and involves most of the stomach |
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Gastric Metastases
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1.Lymph nodes
-local lymph nodes -left supraclavicular nodes (Virchow node) -periumbilical 2.Local invasion -pancreas, duodenum, peritoneal seeding 3.Distant sites (via hematogenous spread) -lungs, liver, brain, ovary (Krukenberg tumor) |
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Gastric Adenocarcinoma Etiology
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-multifactorial
Host genetics: -IL-1B genotype Environment: -variety of dietary factors Pre-existing disease : -H. pylori infection -Chronic atrophic gastritis -Pernicious anemia |
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Gastric Adenocarcinoma Pathogenesis
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pre-existing disease
->intestinal metaplasia ->dysplasia ->adenocarcinoma |
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Gastric Adenocarcinoma Locations
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-Antropyloris(50-60%) > cardia(25%) > body-fundus
-Lesser curvature (40%) -Greater curvature (12%) -Therefore lesser curvature of antropyloric region is a common site. |
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Gastric Adenocarcinoma Morphology
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-Early = spread only in mucosa +/- submucosa
-Advanced = spread into muscularis propria +/- serosa -depth = prognostic factor(even superficial can mets) -Sx arise w/ deeper involvement |
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Gastric Adenocarcinoma Types
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1. Intestinal Type
2. diffuse type |
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Gastric Adenocarcinoma Intestinal Types
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Pathogenesis:
-Chronic gastritis w/ intestinal metaplasia → dysplasia → adenocarcinoma -Arises from metaplastic intestinal epithelium → intestinal gland +/- mucin Growth : in expanding front |
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Gastric Adenocarcinoma Diffuse Types
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Pathogenesis:
-Arises from gastric mucous cells → poorly differentiated, -dis-cohesive (don't form glands) mucous cells = 'signet ring cells' - +/- desmoplasia Growth : infiltrative spread of single cells, cell clusters or sheets |
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Gastric Adenocarcinoma Prognostic factors
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Significant prognostic features:
-depth of invasion(histologic stage) -extent of nodal and distant metastases(clinical stage) Not as significant : type of adenocarcinoma(i.e. intestinal and diffuse) |
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Gastric Lymphoma Basics
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Names: gastric lymphoma = MALT lymphoma = MALToma
Type : low grade B cell lymphoma |
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Gastric Lymphoma Pathogenesis
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Helicobacter pylori infection
->chronic inflammation(expansion of MALT) including influx of B cells; the likely substrate for lymphoma development. |
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Gastric Lymphoma Natural history
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-some regress with H. pylori eradication
-indolent growth(excellent 5 yr survival s/p surgical removal) -may transform to high grade lymphoma, with poorer survival |
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Gastric Lymphoma Gross
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any gross pattern
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Gastric Lymphoma Histopathology
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Small malignant lymphocytes infiltrate mucosa and destroy gastric glands (lymphoid-epitheliod lesion)
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H Pylori Prevalence/associations
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Prevalence:50-60% worldwide
-Developing world = 70 - 80% USA and developed world = 10 – 30% Associations: -Gastritis(acute and chronic) 80 - 90% -Peptic ulcer disease 10 – 15% -Gastric adenocarcinoma 1% -Gastric MALToma 0.01% |
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H Pyloori, Dx / Tx
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Diagnostic methods:
-Non-invasive: serology, stool, breath test -Invasive or biopsy based: urease, histology Treatment Regimen: PPI with 2 antibiotics for 10-14 days recommended: PAC, PMC, PBMT |
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H. Pylori Transmition
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-Gastro-Oral
-Vomit has highest bug load -Black/hispanic |
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Gastric Cancer Epidemiology
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-Second leading cause of cancer mortality
-Significant geographic variability(Asia=40-80, Latin America=10-50, USA=5-10 -Male-female ratio, 2:1 -Decreasing incidence globally |
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Gastric Cancer Clinical presentation
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Insidious:
-dyspepsia -nausea -satiety Advanced: -emesis -bleeding -mass |
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Gastric Cancer Diagnosis/prognosis
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-Endoscopy as procedure of choice
-Staging: CT, EUS, Surgery -Prognosis:TMN staging system |