Gastric Neoplasia: Jackson

Question 1

What leads to the development of inflammatory/hyperplastic gastric polyps?
Characterize these polyps.

Answer 1

Chronic inflammation; H. pylori is a contributor (–>atropic gastritis)
Located in the antrum, often multiple, small, rare malignant potential

Question 2

What are the 2 types on non-neoplastic polyps that are found in the fundic gland?
What is associated with their development?

Answer 2

1. Sporadic - B-catenin GOF; PPI use
2. Syndromic - APC mutation/FAP
   Syndromic has a higher risk of malignancy than sporadic, but both have very low malignancy potential.

Question 3

What are the types of neoplastic polyps that are found in the stomach?

Answer 3

- Adenoma (pre-cancerous)
Cancerous:
- Adenocarcinoma (>90%)
- Linitis plastica (5%, a morphologic variant of diffuse adenocarcinoma)
- Lymphoma (3%)
- Carcinoid (0.2%)
- GIST

Question 4

What are risk factors for gastric cancer?

Answer 4

• chronic atrophic gastritis
• pernicious anemia
• prior gastric surgery
• high dietary nitrates
• adenomatous gastric polyps
• H. pylori infection
• a decrease in pH of the stomach helps grow bacteria, which produce nitrate reductase; this can increase the production of nitrates in the stomach which are mutagenic

Question 5

What are symptoms of gastric cancer?

Answer 5

• weight loss (MC)
• pain (esp. if perineural infiltration)
• nausea
• dysphagia
• melena (esp. if ulceration)
• early satiety
• ulcer-type pain

Question 6

What is the work-up for gastric cancer?

Answer 6

1. upper endoscopy
2. biopsy any lesions (ulcers and masses)
3. CT to stage the tumor
4. EUS to assess invasion

Question 7

What is the treatment for gastric cancer?

Answer 7

• surgery is the only definitive cure - but if it can’t all be excised, surgery may be used for palliative care
• chemo prior to surgery may improve survival in surgical candidates
• if there are metastases, prognosis is poor

Question 8

Describe the two types of gastric andenocarcinoma.

Answer 8

Intestinal and Diffuse:

1. Intestinal = seen in older pts, men>women; characterized by bulky antral masses with the cell architecture typical of cancer on histology; associated with LOF in APC gene, GOF in B-catenin, and KRAS/p53 mutations
2. Diffuse = often in young pts, no sex difference; infiltrates the wall and thickens it; this is where linitis plastica comes in (“leather bottle” mucosal appearance), may be hard to identify on endoscopy because the malignant cells are mostly in the submucosa; signet ring cells on histology; associated with LOF in CDH1 gene which encodes E-cadherin

Question 9

Virchow’s Node

Answer 9

the enlarged L supraclavicular lymph node seen when gastric carcinoma drains there

Question 10

Sister Mary Joseph node

Answer 10

the periumbilical nodule seen when gastric carcinoma metastasizes there