Benign neoplasms of the stomach. Nonepithelial malignant tumors of the stomach

26.04.2017

A benign form of a tumor in the stomach is a neoplasm that is included in the group of histogenesis processes (epithelial and non-epithelial).

These processes come from different gastric layers. They develop slowly and with adequate treatment have a favorable prognosis.

The tumor is manifested by pain in the epigastric region, gastric bleeding, often a feeling of nausea is accompanied by vomiting.

To make a diagnosis, the patient must undergo a series of studies in the form of radiography of the stomach, fibrogastroscopy and histological examination of tumor tissues.

Remove the neoplasm using surgery or endoscopic method.

A benign tumor is diagnosed in 5% of cases of gastroenterological tumors. Neoplasms come from the mucous, submucosal, muscular layers of the stomach, as well as from the epithelial, nervous, vascular and fatty structures.

By growth, the neoplasm is divided into:

endogastric, growing towards the gastric lumen;
exogastric, growing towards nearby organs;
intramural, grows into the walls of the stomach.

Types of benign neoplasms in the stomach

A benign neoplasm can be epithelial or non-epithelial, depending on its origin.

Epithelial formations of the gastric walls include single or multiple adenomatous and hyperplastic polyposis, diffuse polyposis. The growths look like a tumor-like epithelial neoplasm in the gastric lumen.

They have a leg with an elongated base. They are spherical or oval in shape. The surface plane of the polyps has a smooth or granulation structure, and inside them is a dense content.

Diagnosed in men aged 42 to 65 years in the pyloroanthral region. The tissues of the growths consist of growing tectorial epithelium, glandular elements and tissue consisting of connective cells. benign tumors The stomach is equipped with vessels.

Adenomatous polyp of the stomach is a direct benign tumor of the glandular epithelium, which consists of a papillary or tubular structure. Pronounced cellular dysplasia and metaplasia.

Adenomas are dangerous because benign cells develop into malignant ones, which leads to stomach cancer.

More than half of benign tumors of the epithelial tissue of the stomach are polyps, similar to tumors (hyperplastic).

They develop due to an increase in structural elements in the integumentary epithelium. In isolated cases, a hyperplastic polyp can turn into a malignant tumor.

Diffuse polyposis may consist of hyperplastic and adenomatous polyps.

Nonepithelial neoplasms are less common. They develop inside the gastric walls in the submucosal, muscular or subserous layers.

They are formed from muscle, fat, connective tissues, vessels and nerves, it can be: myoma, neurinoma, fibroma, lipoma, lymphangioma, hemangioma, endothelioma.

Tissues of the pancreas and duodenal glands can form dermoid, osteoma, chondroma, hamartoma and heterotopia.

Non-epithelial benign formations in the stomach are diagnosed in female representatives. In rare cases, they can be of considerable size with a clear contour, they are round in shape with a smooth surface.

Leiomyoma is one of the most common benign tumors of the stomach. It develops in the muscle layers, grows towards the serous membrane and grows into the gastric mucosa. This may lead to bleeding. Non-epithelial benign tumors of the stomach can develop into cancer.

Causes of a stomach tumor

Doctors have not determined the exact reasons due to which a benign tumor of the stomach may occur. But there are factors that predispose to this disease.

Chronic inflammatory process of the mucous membrane of the inner lining of the stomach (gastritis), leading to impaired regeneration. He will atrophy epithelial cells and replaces normal glands with fibrous tissue.
Infection with spiral bacteria (Helicobacter pylori). Bacteria contribute to increased release of hydrochloric acid, which eventually reduces the properties of the inner lining of the gastric walls.
genetic predisposition. If there were such diseases in the family, then the risk increases by 70%.
Abuse of alcoholic beverages and smoking.
Wrong nutrition. The diet should be balanced and rich in vitamins. Salty, fried, smoked foods irritate the stomach walls. Fresh vegetables and fruits should be on the menu every day.
Reduced immunity.
Bad ecology.

Symptoms

The main feature of a benign tumor of the stomach is that it does not have pronounced symptoms.

The disease can proceed for a long time and does not give itself away.

Over time, the patient begins to complain of aching or dull pain in the stomach. When the tumor becomes significant, the patient feels heaviness in the stomach and this does not depend on food intake.

Often there is an eructation, nausea with a gag reflex. The patient loses his appetite, he noticeably loses weight. The body is weakened, constantly dizzy and I want to sleep.

One of the symptoms is vomiting and tarry stools.

Symptoms of polyps:

pain syndrome with a pulling and pressing character in the epigastric region. May last several hours after a meal;
frequent belching;
in the sternum constant feeling burning sensation;
regular diarrhea or constipation.

Polyposis gives itself out as a hemorrhage. Bleeding is determined by laboratory research, which define occult blood.

Bleeding chronic form can lead to anemia.

Leiomyomas do not show any symptoms. The only time when a necrotic change in muscle tissue begins is that internal bleeding can begin. The patient experiences weakness, loses weight and is diagnosed with iron deficiency anemia.

Diagnosis of a tumor of the stomach

To make a final diagnosis to specialists of insufficiently pronounced symptoms, he needs to conduct laboratory tests.

Therefore, the symptoms of a benign tumor of the stomach are similar to peptic ulcers, cholelithiasis and colitis.

For an accurate diagnosis, doctors examine the stomach with an endoscope and x-ray. Radiography allows you to determine the number of neoplasms, their size and localization.

In the pictures, the polyps have the correct shape and smooth outlines. The mucous membrane surrounding the stomach remains unchanged.

Gastroscopy allows you to notice neoplasms of small sizes that were not seen on x-rays.

The main feature of endoscopy is that it is possible to take biomaterial with the help of a biopsy and conduct a morphological study.

The final diagnosis can be made after a comprehensive examination, including radiography, endoscopy, targeted biopsy and cytological examination.

Treatment of a benign neoplasm in the stomach

Benign neoplasms in the stomach are removed only by surgery. If doctors find polyps in the stomach, then a gastroscopy is performed. When esophagogastroduodenoscopy is performed, all neoplasms are removed with a flexible tube.

Esophagogastroduodenoscopy - diagnostic examination, including examination and assessment of the condition of the internal surfaces of the esophagus, gastric walls and duodenum. Inspection is carried out with an optical instrument (endoscope).

If there are few neoplasms, then they are removed, otherwise a part of the gastric wall is removed. After removal of the tumor, a small part of it is taken for histological examination to determine the presence of malignant cells in it.

If doctors diagnosed diffuse polyposis, then the stomach is removed completely. After removal of the tumor, the patient must undergo a course of drug therapy.

The doctor prescribes:

A drug that allows you to produce hydrochloric acid in a smaller amount.
If the secretion of hydrochloric acid has been increased as a result of infection with pathogenic microbes that have reduced the protective properties of the inner lining of the gastric wall, then an antibiotic is prescribed that will destroy and slow down the growth of bacteria.

Forecast

After adequate treatment, doctors put a favorable prognosis. But there are exceptions in the form of relapses.

Therefore, patients with such a diagnosis are under the strict supervision of doctors.

The main consequences of a benign tumor in the stomach:

benign neoplasms can develop into stomach cancer;
a hole may form in the gastric walls, as a result of which severe inflammation of nearby organs begins;
the gastric lumen decreases or narrows. Basically, this is due to the large size of the tumor;
deep defects of the inner surface of the neoplasm appear, ulcers form;
stomach tumor is bleeding.

If you watch your diet and keep healthy lifestyle life, it is possible to avoid a benign tumor of the stomach.

Benign tumors of the stomach are a fairly large group of neoplasms that can affect any of the layers of the stomach. Although benign tumors have a certain degree of proliferativity (that is, the ability to grow and develop), unlike malignant tumors, they do not pose a threat to life.

Table of contents:

common data

Among all oncopathology of the stomach, benign tumors occur in 4% of cases. Men get sick more often than women - the ratio is approximately 60% to 40%.

In the maximum majority of cases, benign tumors of various parts of the stomach affect people of the older age category. The peak of the disease occurs over the age of 50 years - more than two-thirds of all patients. At a young age (from 18 to 35 years), cases of morbidity are quite rare, their number begins to increase after the age of 40.

In the last 10 years, the incidence of benign tumors of the stomach has decreased. This trend is attributed to the fact that doctors have learned to identify and treat. She was traditionally credited with participating purely in the formation of malignant tumors of the stomach, but the recorded decrease in the incidence of benign gastric tumors with successful treatment of Helicobacter pylori pathology pushes new conclusions from oncologists-gastroenterologists.

Benign tumors of the stomach leave a large group of diseases. The division within the group is carried out according to the type of tissue from which the neoplasm began to grow.

Causes and development

Oncology of the stomach as a branch of medicine is faced with a problem that is typical for oncology in general: the immediate causes of the transformation of normal tissues of this organ into tumor tissues are still unknown. But the factors contributing to the occurrence of such tumors are highlighted - first of all, these are:

chronic bacterial infection- a spiral-shaped bacterium, which is mainly detected in the pyloric section of the stomach. Toxins, which are produced by Helicobacter, destroy normal cells of the gastric mucosa, in their place, altered cells begin to grow, from which a benign tumor is formed in the future;
atrophic, characterized by a lack of nutrition of the gastric mucosa and its concomitant inflammation;
genetic predisposition(the presence of benign tumors in the family, the detection of the IL-1 gene, which contributes to the degeneration of stomach cells);
malnutrition, due to which normal physiological processes in the layers of the stomach are disrupted, and this, in turn, leads to a failure in the formation and growth of normal cells;
living in ecologically disadvantaged areas;
oppression(immunosuppression);
alcohol;

Oncological influence of all bad habits similar to the influence of Helicobacter - they contribute to the destruction of normal cells of the stomach, which are reborn or replaced by atypical cells that form the basis of the tumor . The only difference is that Helicobacter can act on the cells of the stomach faster, while addictions lead to the oncological process gradually - sometimes over many years (this does not apply to persistent alcoholism and drug use).

Majority benign neoplasms the stomach has a similar pathogenesis (development) - it is either the degeneration of normal cells, or the formation of new, atypical ones. The development of the tumor is virtually uncontrollable - it can either grow throughout life or grow to enormous sizes in a short time.

Main varieties

Of the benign neoplasms of the stomach, the most common are:

Menetrier's disease - proliferation of the gastric mucosa with the formation of adenomas and cysts;
leiomyoma - a tumor that develops from individual fibers of the muscular layer of the stomach;
lipoma - fatty growth, which often begins to grow from the submucosal layer of the stomach;
angioma - a benign neoplasm that develops from the walls of blood vessels that supply blood to all balls of the stomach;
neurinoma - a tumor formed from nerve structures that are involved in the nerve supply of both the stomach as a whole and its individual layers;
fibroma - a neoplasm growing from the connective tissue of the gastric elements.

Of all benign oncopathologies of the stomach, the most significant are:

Menetrier's disease.

Symptoms of benign tumors of the stomach

All of these tumors are similar in that they can long time do not manifest themselves in any way - they are often detected by chance during an examination of a patient for some other pathology of the gastrointestinal tract. General non-specific signs, which, however, can also occur in other non-tumor diseases of the gastrointestinal tract, are:

inexpressive;
infrequent;
feeling, infrequent (in particular, in violation of the diet).

If the tumor nodes die for some reason, the symptoms are more pronounced - namely, the following are observed:

increased pain in the abdomen;
signs - vomiting, in which the vomit resembles coffee grounds, emptying stool characteristic appearance (they are called melena - this is a liquid dark fetid feces, which becomes such due to the admixture of blood);
an increase in general symptoms - deterioration of well-being, weakness,. Such signs depend on the severity of gastrointestinal bleeding accompanying necrosis of the tumor node.

Complications

Very often, benign tumors "live" in the stomach for many years and do not cause functional inconvenience and physiological discomfort. They appear when complications occur - first of all, these are:

Diagnostics

It is often difficult to diagnose a benign tumor of the stomach on the basis of complaints alone, so additional research methods should be used.

Physical examination data are uninformative:

the appearance of patients is not changed, the skin and mucous membranes are of normal color;
when probing the abdomen, there may be slight soreness in the projection of the stomach, but it is more likely to be associated with a violation of the diet than with a benign tumor.

The most important in the diagnosis of most benign tumors are instrumental methods diagnostics, namely:

Treatment of benign tumors of the stomach

Treatment of benign tumors of the stomach can be:

conservative;
operational.

Conservative treatment is carried out if the tumor does not progress, and the patient does not agree to its removal. These treatments are based on the following:

proper nutrition in compliance with the principle of mechanical, chemical and thermal sparing of the stomach;
replacement therapy for functional disorders secretory function of the stomach, which can lead to a decrease in the production of digestive enzymes - natural gastric juice, hydrochloric acid, trypsin.

Operative tactics are resorted to in case of severe symptoms, tumor growth, and also in order to prevent complications from the tumor.

Surgical intervention is:

After a benign tumor of the stomach is removed, appoint:

treatment with inhibitors proton pump that prevent the development of various dyspepsia, gastritis and;
antihelicobacter drugs.

Prevention

Since the true causes of benign tumors of the stomach are unknown, it is difficult to talk about specific prevention. To prevent the occurrence of these pathologies, it is necessary:

adjust the diet;
exclude from food mechanical, thermal and chemical aggressors (coarse, hot and spicy food);
quit smoking - nicotine leads to spasm of the stomach vessels, which is fraught with a violation of physiological processes in its wall;
do not abuse alcohol, which can act as a chemical aggressor;
time to treat diseases of the stomach.

At the age of 50 years and older, you should undergo an annual preventive examination by a gastroenterologist.

Forecast

The prognosis for benign tumors of the stomach is generally favorable. But due to possible relapses or complications, such patients should always be under the control of a gastroenterologist and an oncologist. Clinical alertness should arise in Menetrier's disease and gastric polyps that are prone to malignancy.

Polyps of the stomach

They make up the vast majority of benign neoplasms of this organ. . Characteristics of these neoplasms:

By quantity they distinguish:

single polyp;
multiple polyps (from 2 to 5);
stomach polyposis.

note

The boundary between the diagnoses of "Multiple polyps" and "Polyposis of the stomach" is rather arbitrary. The last diagnosis can be made with five polyps, but in the case of revealed heredity.

According to their structure, gastric polyps are divided into:

adenomatous - are formed from the glandular cells of the stomach. This type of polyps is the most dangerous, since in 20% of cases they are reborn into malignant tumors. Most often, malignancy (malignancy) affects polypous outgrowths more than 1.5 cm long;
hyperplastic - are formed in patients with atrophy of the gastric mucosa (especially with an associated inflammatory process, when the so-called atrophic gastritis occurs). They make up more than 80% of all gastric polyps, but very rarely degenerate into malignant tumors;
inflammatory-connective tissue - appear against the background of an inflammatory process from the side of the gastric mucosa (less often - with inflammation of other layers of this organ). Such polyps are literally crammed with eosinophils - cells, the number of which increases in the blood with allergization. But the allergenic nature of these outgrowths has not yet been proven. In terms of tissue structure, they are not true tumors. But inflammatory-connective tissue polyps appearance very similar to classic benign tumors, which is why clinicians classify them as neoplasms.

Small polyps very often do not provoke any clinical signs.

Symptoms can only appear when the polyp has grown to a large size and interferes with the work of the stomach, affecting its internal stable environment. . In such cases, the following symptoms may appear:

aching, moderate intensity (mostly after eating);
general symptoms - weakness, dizziness (due to anemia due to bleeding);
nausea and with streaks of blood, and sometimes with detached fragments of the polyp;
in some cases - change and.

The most accurate method for diagnosing polyps is to examine the stomach with an endoscope (probe with built-in optics). During fibrogastroscopy, a biopsy of the stomach tissue is performed - a small fragment is taken for microscopic examination. Also, polyps are often an accidental finding during operations on the stomach for another pathology.

The treatment of gastric polyps is based on a combined approach - observational and surgical. Ultimately, gastric polyps must be removed to avoid the risk of malignancy.

Menetrier's disease

Menetrier's disease is a special kind of benign lesion of the stomach, which is considered a precancerous condition. With this disease, the gastric mucosa grows several times and provokes the further formation of adenomatous growths and cysts. Pathology is also called chronic hypertrophic polyadenomatous gastritis. This disease is most often observed at the age of 30-50 years (men get sick three times more often than women).

note

Unlike other benign lesions of the stomach, Menetrier's disease often occurs in childhood.

With this disease, the height of the folds of the gastric mucosa is about 2-3 cm, or even more. Most often, the pathological process is observed along the greater curvature of the organ. . In Menetrier's disease, the production of mucus by the glands is increased, so the glands are swollen, which contributes to the formation of small multiple cysts from them, as well as glandular tumors (adenomas).

The factors contributing to the development of Menetrier's disease are the same as those that provoke the occurrence of other benign tumors of the stomach. But highest value have:

violation of the diet;
alcohol abuse;
lead intoxication (in industrial production);
lack of vitamins (especially representatives that provide normal growth and tissue development)
some infectious pathologies (viral liver damage,);
metabolic failure;
neurogenic factors (violation of the nervous regulation of the gastric mucosa by the central and autonomic nervous system);
allergization of the body;
anomalies that occur during the intrauterine development of the fetus (especially at the stage of laying the food tube);
permanent inflammatory processes in the gastric mucosa.

Often the disease develops gradually, slowly (quite rarely there is an acute onset). Most frequent clinical manifestations diseases are:

Depending on the predominance of certain symptoms, there are three variants of the disease:

asymptomatic;
dyspeptic - with a predominance of nausea, vomiting and stool disorders;
pseudotumor - with a predominance of common signs (weight loss, weakness, loss of vitality).

Menetrier's disease can take place with periods of prolonged remission (subsidence of the process).

The diagnosis is made on the basis of typical complaints, and is also supported by physical and additional methods examinations.

On palpation of the abdomen, medium degree severity of pain in the upper abdomen.

Instrumental research methods used to diagnose Menetrier's disease are:

Laboratory methods that are informative in the diagnosis of Menetrier's disease are:

complete blood count - there is a moderate decrease in the number of erythrocytes and hemoglobin, as well as leukocytes
study gastric juice- determine the deterioration in the production of hydrochloric acid;
examination of the mucosal biopsy - determine the changes characteristic of adenomas and cysts.

Menetrier's disease should be distinguished from such diseases of the stomach as:

hypertrophic gastritis (growth of the gastric mucosa, but without the formation of adenomas and cysts);
polyps;
malignant gastrotumours.

Menetrier's disease is treated:

conservatively;
promptly.

Conservative treatments include:

mechanically, thermally and chemically sparing diet with a high protein content;

The second circumstance limiting the widespread use radiation treatment, is its futility in cancer with metastases to distant organs. Radiation methods are applicable for locally advanced inoperable cancer of the cardia. Therefore, the most promising method for the treatment of inoperable forms of cardia cancer is medication.

The use of 5-fluorouracil in some cases leads to an objectively recorded decrease in the tumor and in other cases to a symptomatic effect (NG Blokhina, 1977). The drug was administered intravenously at a dose of 0.75-1 g every other day (15 mg/kg). The course dose was 4.5 g. The treatment was repeated after 1-1"/2 months until the patient's condition allowed (Fig. 106).

Combination chemotherapy for gastric cancer is in stages scientific development. Combination different drugs involves the impact on various links in the chain of metabolism of the tumor cell through a combination of drugs with different mechanisms of action. The toxicity of a combination of several drugs (polychemotherapy) should not exceed the toxicity of a single drug.

Unfortunately, in half of the patients treated with 5-fluorouracil and a combination of drugs, no tangible effect was obtained. Therefore, attempts to use intra-arterial regional methods of treatment, in which the drug was administered fractionally over several days through a catheter inserted into the celiac artery, seemed quite justified. This made it possible to introduce a highly concentrated drug into the zone of an intractable tumor and nearest metastases with a lower risk of getting general toxic complications. The use of this method in the Oncology Center of the Academy of Medical Sciences of the USSR in 12 patients with cancer of the cardia (U. Sh. Shaikhiev, 1968) gave an objective positive result only 4 patients. VA Cherny (1969) also did not receive convincing success in the treatment of 44 patients with the method of regional chemotherapy of gastric cancer. Regional chemotherapy for gastric cancer has not justified itself.

Methods of conservative (radiation and drug) treatment of cancer are only developing, and it is too early to evaluate their effectiveness in cancer of the cardia.

Thus, the main thing in the treatment of proximal gastric cancer is the improvement of surgical methods of treatment. In connection with handicapped radical surgery and a high percentage of relapses and tumor sampling in the first 2 years after it, the main attention should be paid to the search for therapeutic methods of treatment.

NONEPITHELIAL MALIGNANT TUMORS OF THE GASTRIC

Primary sarcoma of the stomach is quite rare and accounts for about 4-5% of all malignant tumors of the stomach. The ratio among sick women and men is 1.4:1.0, i.e., there is a certain predominance of women. By age, these patients are much younger than patients with stomach cancer (V. N. Gerasimenko, E. O. Kovalevsky, A. A. Klnmen-

Localization of sarcomas does not follow the patterns that are characteristic of cancerous tumors. Sarcomas are most often located along greater curvature stomach, then on the anterior and posterior walls, along the lesser curvature. Much less often, sarcomas are localized in the antrum of the stomach.

Almost all histological types of sarcomas are found in the stomach, but reticulosarcomas (lymphosarcomas) predominate, then myosarcomas, fibrosarcomas, malignant neuromas, polymorphic cell sarcomas, etc.

According to the nature of growth and distribution in the stomach, these tumors are divided into:

1) exogastric;

2) endogastric;

3) intramural (infiltrating);

4) endoexogastric.

Exogastric sarcomas affect a limited area of the stomach. Growing from under the serous cover, exogastric forms of sarcomas grow in abdominal cavity, pushing, squeezing and sprouting neighboring organs. Usually these tumors have a rounded tuberous or lobular shape and reach a huge size, descending in some cases into the cavity of the small pelvis. The mucous membrane of the stomach in this form suffers, as a rule, a little.

Depending on the localization, direction of growth and distribution, an appropriate clinical picture is observed.

Endogastric sarcomas grow into the lumen of the stomach in the form of small polyps, often on a broad base, coming from the submucosal layer. They do not reach large sizes. The mucous membrane around the tumor changes little. Necrobiotic changes in the tumor are possible during the growth of the sarcoma. AT clinical picture the symptoms of impaired patency of food and evacuation of the contents of the stomach predominate.

Intramural (infiltrating) sarcoma accounts for about 60% of all forms. It differs by faster infiltrating growth along the gastric wall, the stomach grows over a large extent from the pyloric region to the cardia. By the nature of growth it resembles infiltrating gastric cancer. If the tumor occupies a smaller area, it may have the appearance of tuberous nodes that undergo disintegration with the formation of extensive ulcers.

Mixed (exo-endogastric) sarcomas in the lumen of the stomach grow like an endogastric tumor, but spread more into the abdominal cavity as an exo-gastric one, reaching large sizes. Internally, these tumors are connected by a stalk various shapes and length, sometimes relatively narrow. Almost 30% of sarcomas give early metastases to regional The lymph nodes. The first two forms have a more favorable course.

Clinic. The clinical course of gastric sarcomas is very diverse. With exogastric growth, when the bulk of the tumor is located outside the stomach, symptoms associated with the germination of neighboring organs (liver, pancreas, intestines) come first. Exogastric sarcomas can reach very large sizes, descend into the small pelvis and simulate a tumor of the female genital area. The pain syndrome is especially pronounced. In most cases, the tumor is palpable. Attention is drawn to the discrepancy between the general satisfactory condition of the patient and the size of the palpable tumor. Bleeding into the lumen of the gastrointestinal tract is rare. Usually, with these forms of the tumor, dyspeptic phenomena are absent and appear only in the advanced stage of the disease.

Significant difficulties for diagnosis are endogastric, intramural and mixed forms of sarcomas. The clinical, radiological and endoscopic picture resembles gastric cancer. Unlike cancer, achlorhydria is observed much less frequently, and anemia occurs in only 25% of patients. Rapidly progressive weight loss, increasing weakness, fatigue, apparently associated with the rapid absorption of decay products

a growing tumor, severe pain of a permanent nature, vomiting, a short (1-6 months) history of the disease may indicate gastric sarcoma. In addition to these symptoms, the clinical picture may be dominated by phenomena associated with various complications of gastric sarcoma.

Due to the disintegration and bleeding from the tumor into the lumen of the stomach or abdominal cavity, corresponding symptoms occur, sometimes requiring emergency surgical intervention. A feverish state is most often associated with an infected decaying tumor, up to the development of peritonitis. With large exogastric sarcomas on the leg, it is possible to twist it with the subsequent development of peritonitis. Often such patients undergo urgent surgery with a diagnosis of ovarian cyst torsion.

Diagnostics. Diagnosis of gastric sarcomas should be complex, the main role belongs to x-ray examination. The nature of the growth of gastric sarcoma determines the x-ray picture of the changes.

Endoscopic (gastroscopic) diagnosis in exo-gastric and infiltrating forms of sarcomas is based only on indirect data. Due to the submucosal growth of the tumor, it is extremely difficult to obtain morphological confirmation of the diagnosis. With endogastric and mixed forms of growth, in some cases it is possible to make a biopsy. With endo-g astral tumors emanating from the anterior wall of the stomach, laparoscopy can help with the correct diagnosis.

Preoperative diagnosis of gastric sarcomas is extremely difficult. The diagnosis in most cases can be presumptive before surgery. The final diagnosis is made only after laparotomy and histological examination of the drug. In these cases, the role of urgent histological examination during the operation becomes extremely important.

Treatment and prognosis. The main method of treatment is subtotal resection of the stomach or gastrectomy. With exogastric and endogastric forms of sarcomas, due to the long absence of metastases, the percentage of radically operated patients reaches 70-80. Good long-term results were obtained in 15-20% of patients.

Radiation therapy and medicinal treatment possible only if the tumor is sensitive. This applies mainly to reticulosarcomas (lymphosarcomas) of the stomach.

Radiation therapy is indicated for inoperable reticulosarcomas or as a prophylactic irradiation after radical surgery. Irradiation of an inoperable tumor has two main objectives: direct exposure aimed at obtaining therapeutic effect; transfer of the tumor to an operable state with subsequent surgical treatment. After

surgical removal of gastric reticulosarcoma postoperative radiation therapy aims to increase the radicalism of the operation.

In connection with the development of medicinal methods for the treatment of malignant tumors, the possibility of combining surgical and chemotherapeutic (sarcolysine, cyclophosphamide, endoxan, etc.) methods of treating reticulosarcoma (lymphosarcoma) of the stomach attracts attention. In this regard, it is advisable to conduct preventive courses of treatment after radical operations. Given the sensitivity of reticulosarcomas (lymphosarcomas) to ionizing radiation and chemotherapy, this method should be considered promising.

TUMORS OF THE LIVER, BILE TRACTS,

PANCREAS

- This is a group of neoplasms of epithelial and non-epithelial histogenesis, emanating from different layers of the gastric wall, characterized by slow development and a relatively favorable prognosis. May be manifested by pain in the epigastrium, symptoms of gastric bleeding, nausea, vomiting. The main diagnostic methods are radiography of the stomach and fibrogastroscopy, histological examination of the tumor tissue. Treatment consists of removal of neoplasia by endoscopic or surgical methods.

General information

Treatment of benign tumors of the stomach

Treatment of pathology is only surgical; the method of surgical intervention depends on the type, nature of the tumor and its localization. In the absence of reliable criteria for malignancy, it is necessary to remove all identified neoplasms. The main methods for removing benign tumors at present are minimally invasive endoscopic electroexcision (or electrocoagulation), enucleation, gastric resection, and rarely gastrectomy.

Endoscopic polypectomy is performed for small single polyps localized in different parts of the stomach: with a size of less than 0.5 cm - by cauterization using a point coagulator, with a size of 0.5 to 3 cm - by electroexcision. For large single polyps on a wide base, surgical polypectomy is performed (excision within the mucous membrane or with all layers of the stomach wall) with preliminary gastrotomy and revision of the stomach.

With multiple polyps or suspected malignancy, a limited or subtotal resection of the stomach is performed. After polypectomy and resection, there is a risk of incomplete removal, recurrence and malignancy of the tumor, development of postoperative complications and functional disorders. Gastrectomy may be indicated for diffuse polyposis of the stomach.

During the removal of non-epithelial neoplasia, an urgent histological examination of tumor tissues is performed. Small neoplasms growing in the direction of the lumen of the stomach are removed endoscopically; encapsulated tumors are excised by enucleation. Large, hard-to-reach endo- and exogastric neoplasias are removed by wedge-shaped or partial resection, if malignancy is suspected, resection is performed in compliance with oncological principles. After operations, dynamic monitoring by a gastroenterologist with mandatory endoscopic and radiological control is indicated.

Approximately nine out of ten gastric neoplasms are malignant. One tenth are benign tumors. As a rule, they do not threaten the life of the patient and give a favorable prognosis. But it happens that some of them undergo malignant transformation. Therefore, patients with such a diagnosis should be observed by a gastroenterologist, undergo an annual examination, treatment, and monitor their diet. What are the symptoms and what are the prognosis for recovery in patients?

The nature of neoplasms

Each tumor of the stomach has its own tumor growth and cellular origin. Among neoplasms benign the vast majority are polyps. Polyps are glandular neoplasms that grow into the lumen of the stomach, with a rounded shape, on a thin stalk and with a wide base. According to quantitative characteristics, the concept of a single polyp and multiple (polyposis) are divided.

Tumor classification by histology:

in muscle tissue (leiomyoma);
submucosal layer (lipoma);
in vessels (angioma);
in nerve fibers(neurinoma);
in connective tissue (fibroma).

Classification of the tumor at the site of localization:

cardiac department (section of the transition of the esophagus to the stomach);
cavity of the stomach;
antral or pyloric section (the lower section at the junction with the duodenum).

Classification of the tumor according to the direction of growth:

endogastric (into the lumen);
exogastric (with compression on the wall from the outside);
intramural (inside the wall).

Until now, medical science has not exactly established why normal tissues are transformed and turn into benign tumors. However, gastroenterologists identify several predisposing factors and conditions in which oncopathology is more likely to form:

Chronic stomach infection (Helicobacter pylori).
Inadequate treatment of gastritis.
A history of atrophic gastritis.
genetic predisposition.
Wrong nutrition.
Bad habits (tobacco, alcohol).
Unfavorable environmental conditions.

Clinical signs and diagnosis

Clinical feature: benign tumors often do not give pronounced symptoms. The disease proceeds for a long time without any complaints from the patient. It can be a dull or aching pain in the stomach area. With the growth of the tumor, the patient complains of a constant feeling of heaviness, regardless of food intake, belching, nausea, and vomiting. He noticeably loses weight regardless of the degree of appetite. He complains of weakness, drowsiness and dizziness. Frequent symptoms- pain attack is accompanied by vomiting, tarry stools.

Polyposis symptoms:

soreness of a pulling and pressing nature in the epigastric region within one to three hours after eating;
belching food or air;
constant burning sensation in the retrosternal region;
diarrhea or constipation.

Polyposis is often complicated by hemorrhages. Minor bleeding is determined by testing for occult blood in the stool.

Chronic bleeding leads to iron deficiency or hypochromic anemia.

Leiomyoma (a neoplasm of muscle tissue) usually does not give symptoms. Only when necrotic changes begin do symptoms of internal bleeding appear in the form of weakness, weight loss, and iron deficiency anemia.

For the diagnosis of a benign tumor of the stomach, the presence of symptoms such as pain for the doctor is not of diagnostic value, because it can accompany both ulcerative and cholelithiasis, colitis

Generally according to this disease objective research is uninformative.

Diagnosis requires endoscopic and x-ray examination.

X-ray specifies the number of polyps, size and location. With polyps, formations are visible in the picture correct form and with even outlines, with unchanged gastric mucosa that surrounds this area.

Gastroscopy is considered more accurate than an x-ray. It makes it possible to detect growths of small sizes that cannot be seen on x-rays. The second advantage of endoscopy is the possibility of taking biopsy material for morphological examination.

A comprehensive examination (X-ray, endoscopy with targeted biopsy and cytology) plays a decisive role in the diagnosis.

Therapy

Surgical treatment of benign neoplasms.

Treatment of polyps is the removal of them using a gastroscope. During diagnostic procedure esophagogastroduodenoscopy, after assessing the condition of the digestive organs using an endoscope, the surgeon excised either the neoplasm itself, or the tumor body with part of the gastric wall. After

tissue excisions are urgently sent to the laboratory for histological analysis.

Treatment of diffuse polyposis is also surgical. Only in this case, a gastrectomy (complete removal of the stomach) is performed.

After it was carried out surgery with excision, medications are prescribed:

drugs that reduce the production of hydrochloric acid;
when infected Helicobacter pylori antibiotic treatment is indicated.

The prognosis for the disease is relatively favorable. From the moment the diagnosis is confirmed, the patient is registered with a dispensary with a mandatory annual full examination. As a preventive measure for the development of benign tumors, you should get rid of bad habits, eat only healthy food and treat gastritis in time.