Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Radiographic or endoscopic evidence of gastric mass• Often accompanied by upper GI bleeding +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Laboratory Findings + • Anemia +++ Imaging Findings + • 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 + • 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 +++ Rule Out + • Adenocarcinoma• Lymphoma• Other gastric neoplasm + • 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 +++ When to Admit + • Severe anemia or apparent upper GI hemorrhage• High-grade obstruction + • Leiomyomas: Enucleation or wedge resection (2-3 cm margin)• Leiomyosarcomas: More radical gastric resection +++ Surgery +++ Indications + • All leiomyomas and leiomyosarcomas• Complete resection of metastases in addition to the primary may improve the outcome +++ Medications + • Imatinib mesylate +++ Complications + • GI bleeding• Gastric outlet obstruction +++ Prognosis + • 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 +++ 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... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.