Ask the Experts
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
