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  • • Radiographic or endoscopic evidence of gastric mass

    • Often accompanied by upper GI bleeding

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Epidemiology

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  • • Represent 1% of all GI malignancies

    • -Stomach is most common site

    • Difficult to distinguish malignant from benign histologically

    • Increased size (> 6-10 cm) correlates with increased risk of malignancy

    • In most cases, the tumor arises from the proximal stomach

    • -Benign tumors more common on lesser curvature

      -Malignant tumors more common on greater curvature

    • Tumors may grow into the gastric lumen, remain entirely on the serosal surface, or even become pedunculated within the abdominal cavity

    • Spread is by direct invasion or blood-borne metastases

    • -Liver most common site of metastases

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Symptoms and Signs

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  • • Often asymptomatic

    • May present with occult or apparent GI bleeding (melena, hematochezia)

    • Weight loss

    • Nausea and vomiting may be present if tumor obstructs gastric outlet

    • Epigastric mass palpable in 20% of patients

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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  • Radiology and endoscopy: Tumor usually contains a central ulceration caused by necrosis from outgrowth of its blood supply

    CT scans: Provide useful information on the amount of extragastric extension

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  • • Contrast radiography or upper GI endoscopy will reveal a gastric mass

    • Endoscopic biopsy that penetrates through the gastric mucosa will usually provide diagnosis but not distinguish benign from malignant

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Rule Out

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  • • Adenocarcinoma

    • Lymphoma

    • Other gastric neoplasm

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  • • Contrast radiography or upper GI endoscopy will reveal a gastric mass

    • Endoscopic biopsy, perhaps guided by endoscopic US, will usually be diagnostic

    • CT scans provide useful information on the amount of extragastric extension

    • Hgb to assess anemia and treat accordingly

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When to Admit

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  • • Severe anemia or apparent upper GI hemorrhage

    • High-grade obstruction

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  • Leiomyomas: Enucleation or wedge resection (2-3 cm margin)

    Leiomyosarcomas: More radical gastric resection

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Surgery

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Indications

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  • • All leiomyomas and leiomyosarcomas

    • Complete resection of metastases in addition to the primary may improve the outcome

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Medications

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  • • Imatinib mesylate

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Complications

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  • • GI bleeding

    • Gastric outlet obstruction

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Prognosis

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  • GIST: 5-year survival rate is 20-55% after resection

    • Tumors with 10 or more mitoses in a high-powered field rarely can be cured

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References

DeMatteo RP et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231:51.  [PubMed: 10636102]
Steeghs N, Nortier JW, Gelderblom H: Small molecule tyrosine kinase inhibitors in the treatment of solid tumors: an update of recent developments. Ann Surg Oncol 2007;14:942.  [PubMed: 17103252]
Zureikat AH, McKee MD: Targeted ...

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