Stomach Path II Flashcards
hypertrophic gastropathy
menetrier and zollinger ellision
can mimic cancer
menetrier disease
excessive TGF-alpha secretion
-unknown cause
protein losing enteropathy
weight loss, diarrhea, peripheral edema
body and fundic involvement
increased risk of adenocarcinoma
premalignant**
nausea, vomiting, loss of appetite, weight loss, hypoalbuminemia, edema, age 30-60yo
menetrier disease
increased risk for adenocarcinoma
tx of menetrier
high protein diet
cetuximab - M-Ab against EGFR
menetrier prognosis
children - goes away
adults - doesn’t go away
zollinger ellison syndrome
gastrin secreting tumor
-gastrinoma
chronic diarrhea and multiple peptic ulcers
increase in number of parietal cells
tx zollinger ellison
block acid production and remove tumor
majority malignant**
ZES path
non-beta islet cell gastrin tumor of pancreas stimulating acid secretion of stomach
auto dom - MEN-1
pancreas, duodenum, or abdominal lymp nodes
majority malignant
diagnosis of ZES
secretin stimulation test
fasting gastrin levels - 3 occasions
gastric acid secretion and pH - > 15mEq/hour
octreotide
best drug for ZES tx
fundic gland polyps
proton pump inhibitor related - secondary to increased gastrin
gastric adenomas
benign
proliferative dysplastic epithelium
in chronic gastritis with atrophy and intestinal metaplasia
risk or carcinoma if >2cm
corkscrew shaped foveolar glands
hyperplastic gastric polyp
epithelial dysplasia
gastric adenoma
3rd most common cause of cancer death worldwide
carcinoma of stomach
80% with h. pylori infection
majority from surface of glandular epithelial of stomach - adenocarcinoma
aggressive
decreasing incidence in US
gastric cancers
going down in incidence in US
the intestinal type **
adenocarcinoma in stomach
two types
intestinal type - non-signet
diffuse type - signet ring
intestinal type adenocarcinoma
non-signet ring
decline in incidence
h. pylori association
APC/WNT pathway
masses that ulcerate
antrum/pylorus
diffuse type adenocarcinoma
signet ring
no decline in incidence
no association with h pylori
E-cadherin mutation
throughout stomach
WNT-APC pathway
control of beta-catenin levels
which goes to nucleus promoting cell division and cell cycle progression
mutation in APC - colon polyps - no destruction of beta-catenin - cells progress to cycle uncontrolled
E-cadherin mutation
signet ring
-diffuse type
cells don’t stick together - diffuse
as well as lobular ca of breast
sister mary joseph
nodule on umbilicus
stomach carcinoma
irish node
axillary
stomach carcinoma
virchows node
left supraclavicular
stomach carcinoma
