eMedicine Specialties > General Surgery > Abdomen

Benign Gastric Tumors

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

Introduction

Background

With the advent of modern techniques and the widespread use of gastric endoscopy, benign gastric wall lesions are now diagnosed more frequently and can be studied using the tissue obtained by biopsy or polypectomy. In the past, the diagnosis of gastric tumors was based on x-ray examination, but, in 1922, Schendler was the first to make an endoscopic-based diagnosis.1

Pathophysiology

All layers of the stomach wall have the potential to produce tumorous growths. In 40% of patients with benign gastric tumors, the lesions are mucosal tumors. Another 60% are nonmucosal based. Gastric polyps are defined as luminal lesions projecting above the plane of the mucosal surface and are relatively frequent in routine pathology practice. Various subtypes of gastric polyps are recognized and divided into nonneoplastic and neoplastic and are also further classified by their association with polyposis syndromes.2
 
The following is a classification of benign gastric tumors (see Media file 2).

 1.- Mucosal tumors
      
         1.1.- Nonneoplastic polyps
            1.1.1.- Not associated with polyposis syndromes 
            1.1.1.1 Hyperplastic polyps
            1.1.1.2 Inflammatory fibroid polyp (eosinophilic granuloma - Vanek tumor)
            1.1.1.3 Xanthoma/xanthelasma
            1.1.1.4 Ectopic pancreas

            1.1.2.- Associated with polyposis syndromes
            1.1.2.1 Hamartomatous polyp (Peutz-Jeghers syndrome)
            1.1.2.2 Juvenile polyps
            1.1.2.3 Cowden disease
            1.1.2.4 Cronkhite-Canada syndrome
            1.1.2.5 Gardner syndrome
 
         1.2.- Neoplastic polyps
            1.2.1 Fundic gland polyp
            1.2.2 Adenomatous polyp
            1.2.3 Gastric carcinoid

 2.- Nonmucosal tumors

         2.1.- Mesenchymal
            2.1.1 Gastrointestinal stromal tumor (GIST)
            2.1.2 Lipoma
            2.1.3 Fibroma
            2.1.4 Glomus tumor

         2.2.- Vascular
            2.2.1 Hemangioma
            2.2.2 Lymphangioma

Frequency

United States

Benign tumors of the stomach are uncommon, with an incidence of 0.4% in autopsy series and 3-5% in upper endoscopic series, most of them performed for unrelated reasons. Polyps account for 3.1% of all gastric tumors, and their frequency increases to almost 90% of benign gastric tumors (Shackelford, 2007).

They can become inflamed or eroded, but bleeding still remains unusual. Large distal lesions have been associated with symptoms of gastric outlet obstruction.2

Mortality/Morbidity

The majority of benign gastric tumors are asymptomatic, but, very rarely, they present with epigastric pain, gastric outlet obstruction, and bleeding. Adenomatous polyps have a truly neoplastic behavior with the potential for the development of malignancy. Also, gastrointestinal stromal tumors (GISTs) have different behavioral patterns, ranging from benign to malignant.

Race

There is no difference in distribution by race.

Sex

Sex distribution depends on the type of tumor and will be discussed in subsequent sections.

Age

Age distribution depends on the type of tumor and will be discussed in subsequent sections.

Clinical

History

  • Many tumors are found incidentally on gastroscopy.
  • Small tumors are usually asymptomatic, but larger tumors can ulcerate and cause occult bleeding and anemia.
  • Large antral tumors cause intermittent gastric outlet obstruction, as manifested by nausea, vomiting, and early satiety. If ulcerated, these tumors may cause epigastric pain similar to a peptic ulcer.

Physical

  • Physical findings are not specific, except for underlying conditions, such as Peutz-Jeghers syndrome, in which patients may have abnormal pigmentation of the oral mucosa, lips, and digits.
  • An abdominal mass may be palpable.
  • Palpation may elicit abdominal tenderness.

Causes

The etiology of benign tumors varies depending on the type of tumor and associated pathology and will be discussed in detail in subsequent sections.

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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  2. Do Youn Park, MD; Gregory Y. Lauwers,MD. Gastric Polyps: Classification and Management. Archives of Pathology and Laboratory Medicne. Accepted October 2007;132 No.4:633-640.

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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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