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 form 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 of 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
• The 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