eMedicine Specialties > General Surgery > Abdomen

Benign Gastric Tumors: Differential Diagnoses & Workup

Author: Andres Fleury, MD, Clinical Assistant Instructor, Department of Surgery, State University of New York Upstate Medical University; Resident, Department of Surgery, Robert Packer Hospital
Coauthor(s): Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic; Michel M Murr, MD, Professor, Department of Surgery, Director of Bariatric Surgery, University of South Florida
Contributor Information and Disclosures

Updated: Nov 26, 2008

Differential Diagnoses

Achlorhydria
Arteriovenous Malformations
Gastric Ulcers

Other Problems to Be Considered

Gastric adenocarcinoma
Gastric lymphoma
Gastric varices
Gastric sarcoma

Workup

Laboratory Studies

  • Findings on laboratory serum tests are nonspecific.

Imaging Studies

  • Air-contrast studies of the stomach are sensitive in delineating mucosal details and lesions.
  • Lesions are often found incidentally by computerized tomography scan or other radiological evaluations of the upper gastrointestinal tract.

Procedures

  • Endoscopy has become more common for both diagnostic and therapeutic purposes. Endoscopic findings that suggest malignancy include red coloring, the presence of surface erosions, and the absence of a pedicle. If small superficial lesions are removed endoscopically, follow-up should include a regular annual endoscopy.
  • Endoscopic biopsies are difficult to interpret and may be misleading because deep layers of the stomach wall or the tumor are not sampled. Snare biopsies that retrieve the whole specimen are preferred whenever technically possible.
  • Endoscopic ultrasound (EUS) is helpful in broad-based lesions, where the relationship of the tumor to the layers of the stomach is important. Disruption of the normal sonographic appearance of 5 layers on EUS may signify invasion.

Histologic Findings

Hyperplastic polyps

There is marked elongation of the pits with branching, resulting in a corkscrew appearance or in cystic dilatation of foveolae. Also, there is an excess of lamina propria with plasma cells, lymphocytes, eosinophils, mast cells, macrophages, and neutrophils. The gastric glands do not normally participate in the formation of the polyps. The surface may be ulcerated and inflamed with regenerative atypia. There may also be invagination of the surface mucosa with budding.2

Inflammatory fibroid polyps

These polyps are centered on the submucosa. Small, thin walled vessels surrounded by spindle cells are arranged in an "onion-skin" pattern. CD 34 positive and c-kit negative.2

Hamartomatous polyps of the Peutz-Jeghers type

Gastric mucosa is less frequently involved than the small bowel and the colon. They are composed by hyperplastic glands separated by branching cores of smooth muscle with atrophy of deep glandular components. Dysplasia is very uncommon.2

Juvenile polyps

These polyps are very rare and are usually associated with juvenile polyposis. They are composed of edematous and inflamed mucosa with tortuosity of the foveolar zones and are easily confused with hyperplastic polyps. There is an association with an increased risk of cancer.2

Gastric polyps in Cowden Disease

The foveolar glands are enlarged and elongated. Smooth muscle fibers are intermingled within the mucosal components and the cystic structures extend into the submucosa.2

Gastric polyps in Cronkhite-Canada syndrome

These polyps are usually associated with lesions in other parts of the GI tract. They are indistinguishable from juvenile polyps and hyperplastic polyps, and they are diagnosed if in the presence of alopecia, nail atrophy, or hyperpigmentation.2

Fundic gland polyps

These are dilated glands lined by fundic epithelium mixed with normal glands. There is usually no inflammation or atypia, but some disordered muscle fibers may be seen.2

Adenomatous polyps

They are composed of tubules or villi of dysplastic epithelium with some degree of intestinal-type differentiation. They can be low grade or high grade, based on the degree of dysplasia. The risk of malignancy is related to the size, the degree of dysplasia, and the villosity of the growth pattern. Forty percent to 50% of lesions greater than 2 cm contain carcinomatous transformation.2

Gastric carcinoids

Gastric carcinoids are very rare, representing less than 0.5% of gastric neoplasms, and are seen in 3 different settings: autoimmune atrophic gastritis, Zollinger Ellison syndrome, and MEN-1 syndrome, or they may be seen sporadically. They are usually broad-based, yellowish polypoid lesions overlined by normal mucosa. Chromogranin A is positive, but chromogranin B is usually negative. Synaptophysin is positive in 50% of cases.2

Staging

Depends upon the type of tumor

More on Benign Gastric Tumors

Overview: Benign Gastric Tumors
Differential Diagnoses & Workup: Benign Gastric Tumors
Treatment & Medication: Benign Gastric Tumors
Follow-up: Benign Gastric Tumors
Multimedia: Benign Gastric Tumors
References
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References

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Further Reading

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Keywords

benign gastric tumors, benign gastric tumor, benign stomach tumors, stomach polyps, gastric wall lesions, hyperplastic polyps, adenomatous polyps, fundic gland polyps, inflammatory fibroid polyps, juvenile polyps, familial polyposis, syndromes, Peutz-Jeghers syndrome, nonmucosal intramural tumors, leiomyoma, fibroma and fibromyoma, lipoma, ectopic pancreas, neurogenic and vascular tumors, cystic tumors, duplication cyst, mucocele

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Contributor Information and Disclosures

Author

Andres Fleury, MD, Clinical Assistant Instructor, Department of Surgery, State University of New York Upstate Medical University; Resident, Department of Surgery, Robert Packer Hospital
Andres Fleury, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and National Hispanic Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Burt Cagir, MD, FACS, Assistant Professor of Surgery, State University of New York, Upstate Medical Center; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic
Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract
Disclosure: Nothing to disclose.

Michel M Murr, MD, Professor, Department of Surgery, Director of Bariatric Surgery, University of South Florida
Michel M Murr, MD is a member of the following medical societies: American College of Surgeons, American Hepato-Pancreato-Biliary Association, American Society for Bariatric Surgery, Association for Academic Surgery, International College of Surgeons US Section, Society for Surgery of the Alimentary Tract, and Southeastern Surgical Congress
Disclosure: Tyco Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David L Morris, MD, PhD, Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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