E-20, Greater Kailash-1, Delhi-110048

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

Following test are required for diagnosis and management

  • Endoscopy and endoscopic ultrasound
  • CECT abdomen
  • PET scan to rule out distant metastasis
  • 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 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.

  • Dyspepsia
  • Epigastric pain
  • Nausea, vomiting and early satiety
  • GI bleeding
  • Fever, vomiting and weight loss

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
  • 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