2.  Anatomy of stomach
 DD of gastric masses

4.  Barium Meal

5.  Reticular pattern
Area Gastricae
 Rugae
 Rosette of folds in gastric cardia

6.  2-3 layered structure
 Max thickness of
stomach wall _4mm

7.  5 layers of bowel
wall
 Wall thickness of
distended
stomach _3 mm

8.  Benign tumours
 Malignant tumours
 Miscellaneous causes

9.  Hyperplastic Polyps
-Local hyperplasia of glandular tissue
-Small , smooth , sessile ,multiple
-Size < 1 cm
-Fundus & body of stomach
-Arise from mucosa affected by chronic
atrophic gastritis.

10.  Dependant part of
stomach__filling
defect
 Anterior wall
polyp__ring
 Small, sessile,smooth
polyps__always benign
 Polyp>1cm OR
irregular
surface__further
workup needed

12.  Majority dysplastic_may undergo
malignant change
 -Tubular -Tubulovillous -Villous
 >1cm ,larger than hyperplastic
 Solitary with nodular surface
 Commonest site__Gastric antrum
 May pedunculate,prolapse in pylorus

13.  Risk of malignant transformation relative
to size
 Carcinoma may co-exist

14.  Include
1. Stromal tumours
2. Neurofibroma
3. Lipoma
4. Hemangioma
5. Lymphangioma
6. Glomus tumour
7. Neural tumour
8. Brunner gland hemartoma
9. Duplication cyst
10. Ectopic pancreatic rest

15.  Difficult to diagnose by endoscopy
because overlying mucosa may be intact
 Large tumours tend to ulcerate
 Smooth bulge into bowel lumen , margins
forming a right angle/obtuse angle with
normal bowel wall.

16.  Complications :
 Necrosis
 Ulceration
 Gastric outflow obstruction
 Intussusception
 Large abdominal mass

17.  Barium Meal:
-clearly defined margins
-if central ulcer present__bull’s eye/target
appearance

18.  CT:
-well defined, homogenous mass
-larger tumours__ulceration, necrosis
-glomus tumour, pancreatic, carcinoid
__ hypervascular
-stromal, glomus tumour, hemangioma
__calcifications

19.  EUS – diagnostic modality of choice
-mass arising from mucularis propria or
muscularis mucosa
-smaller,echo-poor ,well-defined
 >3cm tumors surgically removed

21.  Soft , may change shape with peristalsis
or palpation
 May ulcerate , bleed , intussuscept
 Diagnosed by :
-EUS__echogenic tumour
 Confirmed by:
- CT

23.  Capillary /cavernous type
 Solitary / multiple
-endoscopy for diagnosis
-may complicate into:
 Phlebolith
 GI bleeding

24.  Greater curve of antrum OR
anteromedialy in 1st or 2nd part of
duodenum
 Congenital failure of bowel
recanalization
 Gastric duplication present in early
childhood
 Filled with clear mucinous fluid

26.  Small __ 1-3 cm
 Distal end of greater curve OR proximal
duodenum
 Incidental finding
 If tissue well-diffrentiated,barium study
may show a central niche or fill a short
ductal system.

28.  Complications :
• Pancreatitis
• Pseudocyst
• Adenocarcinoma
 CT – variable appearance
-homogenous , strongly enhancing
tumours OR
-avascular cystic lesions

29.  Include :
1. Gastric carcinoma
2. Lymphoma
3. Malignant stromal tumours (GIST)
4. Kaposi sarcoma
5. Carcinoid tumour
6. Metastatic tumours

30.  Risk factors:
• Atrophic gastritis intestinal metaplasia
dysplasia neoplasia
• Pernicious anemia
• H. Pylori infection
• Partial gastrectomy
• Nitrates intake

31.  Symptoms:
• Anorexia
• Dyspepsia
• Weight loss
• Anemia

32.  Mucosa and submucosa
 90% 5 yr survival rate
 Diffrentiate benign ulcers from ulcerating
malignancy
__nodularity, clubbing, interrupted or
fused mucosal folds

35.  Muscularis propria invasion
 May be
• Polypoid
• Fungating
• Ulcerated
• Infiltrating (linitis plastica)

36.  Stippled calcification
in mucin producing
Ca
 Ulcerated early Ca
resembles benign
ulcer (meniscus sign)
 Large
tumours__obvious
filling defects on
barium studies

39.  Most common mets in stomach from:
• Malignant melanoma
• Ca breast
• Kidney, lung, thyroid, testes

40.  Bull’s eye / target lesion

41. Padsign.CaheadofpancreasMetsfromCabreast

42.  Most common site of GI lymphoma
 H.Pylori __MALT lymphoma
 Coeliac disease __T-cell lymphoma
 Middle aged men
 Doesn’t cause obstruction commonly

43.  Radiological appearance
o Often identical to gastric Ca, benign
ulcers, suspect lymphoma if:
• Giant cavitating lesions
• Pronounced gastric folds thickening
• Multiple polypoid tumours(bull’s eye)

44. CT
-Bulky homogenous tumour
-gastric wall thickness
-perigastric fat plane
preserved
-transpyloric spread
-splenomegally
-multicentricity
__CT used for staging

45.  1% of gastric malignancies
 Fundus and body involved
 Middle age / elderly __ males > females
 Large tumours, might pedunculate
 Central necrosis and ulceration

46.  CT
 Exophytic growth
 Low density
necrotic centre
 Dystrophic
calcification
 Mets to peritoneal
cavity, liver, lung
,bone

48.  Tumour of blood vessels
 1/3rd of homosexual male patients with
AIDS
 Multifocal tumours throughout GIT

49. Diagnosed by
 Endoscopy
-hemorhagic patches on gastric mucosa
 Barium meal
- large polypoid tumors OR
-submucosal nodule,later ulcerates_bull’s
eye lesion
-linitis plastica
 CT
-retroperitoneal LN enlargement
-splenomegaly

50.  Rare in stomach/duodenum
 Slow-growing__distal antrum,lesser
curvature
 Submucosal nodules__may
ulcerate/pedunculate
 Hypervascular__both pri. n liver mets
___assess in both arterial and venous
phase on CT

51.  Extrinsic compressions
 Gastric pseudotumours
 HPS
 Bezoar
 Peptic ulceration

53.  Diagnosed by :
 Endoscopy
 Barium studies
 USG
 CT

54.  Gastric fundal varices
-filling defect on
barium meal
 Intragastric prolapse of
sliding hiatus hernia
-mucosal folds form
the mass
-disappears in
recumbent position

55.  Mass of ingested material
 Dragging sensation/ fullness
 2 types:
 Trichobezoar
-mass of matted hair
-young girls , psychiatric patients
 Phytobezoars
-vegetables/ fruit pith
-unripe persimons, gastric surgery

56.  Diagnosis:
-Barium meal
__filling defect
__outlines the mass
__may penetrate
__mottled appearance

58.  Rapunzel’s
syndrome:
-severe case of
trichobezoar
-extend into small bowel,
even caecum
 Plain radiograph of the
abdomen showing multiple air
fluid levels with dilated small
intestinal loops and a sizable soft
tissue density within the stomach

59.  Congenital anomaly
- Infantile - adult
 Stasis causes __ antral gastritis +
ulceration
 Antrum tapers into >2cm long pyloric
canal

60.  To differentiate from
annular Ca:
 Antral tapering
 Absence of mucosal
destruction
 Intact mucosal folds
passing through
pyloric canal

61.  In advanced cases, may cause gastric
strictures