GIST and Lymphoma

GIST (Gastrointestinal stromal tumor)

Stomach is the most common site for the GIST, other sites include small intestine, rectum, and esophagus
Clinical presentation

  • Asymptomatic lesion detected during endoscopy or CT scan
  • GI bleed in the from of hemetemesis and black colored stools
  • Abdominal pain
  • Obstructive features such as dysphagia, recurrent vomiting, abdominal distension, and severe pain abdomen

Diagnosis
Following test are required for diagnosis and management  
         

  • Endoscopy and endoscopic ultrasound
  • CECT abdomen
  • PET scan to rule out distant metastasis

Treatment                       

  • Small GIST can be followed up
  • Large tumor without metastasis should be operated
  • Unresectable tumors, and in patients where surgery is not feasible, are best treated by chemotherapy with imatinib and sunitinib

 
Gastric Lymphoma
Gastric lymphoma constitute 3-5 % of all gastric tumors. Stomach is the most common extranodal site of lymphoma.

Marginal zone B cell lymphoma of stomach
Marginal zone B cell lymphoma, also known as MALT lymphoma is the most common lymphoma of stomach, chronic H pylori infection leading to chronic gastritis is the underlying cause.

Clinical features

  • Dyspepsia
  • Epigastric pain
  • Nausea, vomiting and early satiety
  • GI bleeding
  • Fever, vomiting and weight loss

Diagnosis
Lesions are usually diagnosed by endoscopy, endoscopic findings are

  • Erythema
  • Erosions
  • Ulcers
  • Growth.
  • Biopsy is taken from the suspicious areas
  • CT and EUS are the investigations required for evaluation of extent of diseases and  metastasis

Treatment

  • Early state disease can be treated by eradication of H Pylori
  • Advanced disease is treated by chemotherapy

Diffuse large B cell lymphoma
The role of H pylori in the pathogenesis is not very clear
Clinical symptoms

  • Epigastric pain and dyspepsia
  • Large tumor may cause obstruction
  • Ulcerated lesion may bleed

Diagnosis

  • Upper GI endoscopy and biopsy are required for the diagnosis
  • Endoscopic findings are large tumor and ulcer
  • Body and antrum are common sites
  • CT/PET and EUS are done for staging

Treatment

  • Chemotherapy with or without radiotherapy is mainstay of treatment

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