Benign tumors of a stomach
Benign tumors of a stomach – group of the new growths of an epitelialny and neepitelialny histogenesis proceeding from the different layers of a gastric wall which are characterized by slow development and rather favorable forecast. Tumors can be shown by pains in an epigastriya, symptoms of gastric bleeding, nausea, vomiting. The main methods of diagnosis of benign tumors are the X-ray analysis of a stomach and the fibrogastroscopy, a histologic research of tumoral fabric. Treatment of benign tumors of a stomach consists in their removal by an endoscopic method or in a surgical way.
Benign tumors of a stomach
Benign tumors of a stomach make 2-4% of total number of all tumoral new growths of body in gastroenterologists. Tumors of a stomach can proceed from its mucous, submucous, muscular or subserous layer; from epitelialny, nervous, vascular, fatty structures. As growth distinguish the endogastralny new growths (growing towards a stomach gleam), ekzogastralny (growing towards the next bodies) and intramuralny (with vnutristenochny growth).
Types of benign tumors of a stomach
Depending on an origin benign tumors of a stomach are divided on epitelialny and neepitelialny. Single or multiple adenomatozny and hyper plastic polyps, diffusion polyposes occur among epitelialny tumors. Polyps represent opukholevidny epitelialny outgrowths in a stomach gleam with a leg or the wide basis, a spherical and oval shape, with a smooth or granulyatsionny surface, a dense or soft consistence. Stomach polyps most often arise at males at the age of 40-60 years, usually settle down in piloroantralny department. Fabrics of a polyp are presented by the expanded integumentary epithelium of a stomach, ferruterous elements and connecting fabric, a rich soyosudama.
Adenomatozny polyps of a stomach - true benign tumors from a ferruterous epithelium consist of papillary and/or tubulyarny structures with the expressed cellular dysplasia and a metaplaziya. Adenomas are dangerous in respect of a malignization and often lead to development of cancer of stomach. To 75% of benign epitelialny tumors of a stomach make the hyper plastic (opukholepodobny) polyps which are arising owing to a focal giperplaziya of an integumentary epithelium, having rather low risk of an ozlokachestvleniye (about 3%). At diffusion to a polypose of a stomach both hyper plastic, and adenomatozny polyps come to light.
Seldom found neepitelialny benign tumors of a stomach are formed in a gastric wall - in its submucous, muscular or subserous layer of various elements (muscular, fatty, connecting fabrics, nerves and vessels). Myomas, nevrinoma, fibromas, lipomas, limfangioma, gemangioma, endotelioma and their mixed options concern to them. Also in a stomach dermoids, osteoma, hondroma, gamartoma and geterotopiya from tissues of a pancreas, duodenal glands can be observed. Neepitelialny benign tumors of a stomach arise at women more often and can sometimes reach the considerable sizes. They have accurate contours, usually rounded form, a smooth surface.
Leyomioma – the most often found benign neepitelialny tumors of a stomach can remain in a muscular layer, grow in the direction of a serous cover or sprout through mucous a stomach, leading to an ulceration and gastric bleeding. Benign neepitelialny tumors of a stomach are predisposed to a malignization.
Reasons of benign tumors of a stomach
The reasons of development of benign tumors of a stomach are finally not found out. From the point of view of the disregeneratorny theory, development of polyps can be connected with violation of regeneration of a mucous membrane of a stomach, diskoordinatsiy proliferation of processes and differentiations of its cages at chronic gastritis. Adenomas of a stomach arise against the background of atrophic gastritis as a result of reorganization of glands and an integumentary epithelium, emergence of an intestinal metaplaziya. Hyper plastic polyps develop at violation of updating and increase in life expectancy of cages, because of excess regeneration of an integumentary and patching epithelium. It is also noted that most often polyps of a stomach arise in zones with the reduced secretion of hydrochloric acid (the lower third of a stomach), at patients with hypo - and an akhlorgidriya.
The geterotopirovanny embryonic fabric which remained in a mucous membrane at violation of pre-natal development can be a source of neepitelialny benign tumors of a stomach.
Symptoms of benign tumors of a stomach
In half of cases polyps of a stomach proceed without clinical manifestations. Symptoms of polyps of a stomach generally are defined by a background disease (chronic gastritis) and complications (a polyp top ulceration, bleeding, a polyp prolapse in a duodenum and impassability of the gatekeeper).
Pains at polyps of a stomach are caused by inflammatory process in the mucous membrane surrounding it, are localized in epigastralny area and have the stupid, aching character. At first they arise after meal, then become constants. Complaints to bitterness in a mouth, nausea and an eructation can be observed. At development of impassability of the gatekeeper - vomiting develops, at infringement of a polyp – skhvatkoobrazny pains in subspoon area and on all stomach begin. The ulceration of a polyp leads to moderate gastric bleeding; at the same time blood in emetic weight, a tar-like chair, an indisposition, pallor of integuments, anemia can come to light. Malignization of polyps, as a rule, occurs imperceptibly therefore suspicion have to cause lack of appetite, weight loss, increase of the general weakness, dispepsichesky frustration.
Clinical symptoms of neepitelialny benign tumors of a stomach depend on their localization, character and growth rate, existence of an ulceration of a surface. Most often neepitelialny tumors of a stomach are followed by the short-term and constant pains arising on an empty stomach after meal, at change of position of a body. At nevrinoma a pain syndrome strong, burning character. The tumor ulceration (especially, gemangioma) can cause the latent or plentiful gastric bleedings with threat for the patient's life.
At the big size of a tumor can be palpated through a forward belly wall. Benign neepitelialny tumors of a stomach can be complicated by peritonitis at a necrosis of new growths; sharp or chronic impassability of the gatekeeper in case of infringement in it of a tumor and its malignant regeneration.
Diagnosis of benign tumors of a stomach
Data of the anamnesis, radiological and endoscopic researches allow to diagnose stomach tumors. At a X-ray analysis of a stomach can point the defect of filling repeating tumor outlines to existence of polyps: accurate, equal contours, a round or oval form, its smeshchayemost in the presence of a leg or an immovability – at a polyp with the wide basis. In a case a polypose of a stomach reveal a large number of defects of filling, different in size. The vermicular movement of walls of a stomach at the same time remains. Signs of lack of a vermicular movement, increase in the size, change of a form, emergence of an illegibility of contours of defect of filling at dynamic observation can speak about a polyp malignization.
The diagnosis is specified at a fibrogastroduodenoskopiya (FGDS) which allows to perform visual inspection of a condition of a mucous membrane of a stomach, recognition and differentiation of polyps from other diseases. Visual differentiation of a good-quality polyp from malignizirovanny is complicated. Usually can confirm an ozlokachestvleniye existence of a polyp more than 2 cm in size, with a hilly lobular surface, the wrong corroded contours. For exact definition of character of a polyp during FGDS the biopsy of suspicious sites with a morphological research of bioptat is carried out.
The diagnosis of a neepitelialny benign tumor of a stomach in most cases can be established only after operation and a morphological research of this new growth. Existence of clinical manifestations (for example, bleedings) indicates a possibility of tumoral process. FGDS is more informative with an endogastralny growth of neepitelialny tumors of a stomach. At intramuralno or ekzogastralno the located tumors at an endoscopic research the stomach sdavleniye from the outside is defined.
The stomach X-ray analysis at neepitelialny benign tumors helps to find roundish or wrong contours of defect of filling with preservation of a vermicular movement and folds on a submucous layer; ekzogastralny growth of a new growth with procrastination of a wall of a stomach; an ulceration with formation of a niche on a tumor top, etc. For detection of ekzogastralny tumors of a stomach can be used by ultrasonography and KT of an abdominal cavity.
Treatment of benign tumors of a stomach
Treatment of benign tumors of a stomach - only surgical; the method of surgery depends on a look, the nature of a tumor and its localization. In lack of reliable criteria of a malignization of benign tumors of a stomach, it is necessary to carry out removal of all revealed new growths. The main methods of removal of benign tumors of a stomach are a low-invasive endoscopic elektroekstsiziya now (or electrothermic coagulation), an enukleation, a stomach resection, it is rare – a gastrektomiya.
The endoscopic polipektomiya is carried out at the small single polyps which are localized in various departments of a stomach: at the size less than 0,5 cm - cauterization by means of a dot coagulator, at the size from 0,5 to 3 cm - an elektroekstsiziya method. At large single polyps of a stomach on the wide basis carry out a surgical polipektomiya (excision within a mucous membrane or with all layers of a wall of a stomach) with a preliminary gastrotomiya and audit of a stomach.
At multiple polyps or suspicion on a malignization carry out a limited or subtotal resection of a stomach. After a polipektomiya and a resection there is a risk of incomplete removal, a recurrence and a malignization of a tumor, development of postoperative complications and functional frustration is possible. Gastrektomiya can be shown at diffusion to a stomach polypose.
During removal of neepitelialny tumors of a stomach the urgent histologic research of tumoral fabrics is conducted. The small good-quality new growths growing in the direction of a gleam of a stomach delete endoscopic; the encapsulated tumors vylushchivat by an enukleation method. Big, remote endo-and ekzogastralny benign tumors of a stomach delete with method of a wedge-shaped or partial resection, at suspicion on a malignization - make a resection with respect for the oncological principles.
After removal of benign tumors of a stomach dynamic dispensary observation of the gastroenterologist with obligatory endoscopic and radiological control is shown.