Benign tumors of the stomach. Benign tumor of the stomach

Inna Bereznikova

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There are a variety of benign tumors of non-epithelial and epithelial origin. Their clinical manifestations also differ in their morphological characters and characteristics. Among them, lipomas, neuromas, neurofibromas and others.

They can be localized in various parts of the stomach: in the cardia, in the cavity of the stomach, in the antrum. They differ in their growth: endogastric, exogastric, intramural. The size of benign neoplasms depends on the walls of the stomach, the presence of gastric bleeding, the presence of ulcerative formations. The development is also affected by the organs preceding the given oncological disease.

There are signs of a clinical picture:

• disturbed processes in the stomach by signs of gastritis disease;
• acute gastric hemorrhage;
• general disorders in the body: decreased appetite, organic fatigue, weight loss;
• the passage of signs of a stenotic symptom in the pylorus of the stomach;
• absolute calm flow;
• completely random identification of a benign formation;
• palpation of the tumor; observation of anemic and dyspeptic disorder.

Symptomatic picture

Clinical features are manifested by a calm and prolonged course, only dull pains are observed, aching and constant in the epigastric region of the stomach. It is not necessary that this follows after eating.

The following are noted:

• dyspeptic disorders;
• feeling of heaviness;
• feeling of nausea
• burping
• vomiting with blood impurities in the masses;
• tarry stools;
• a decrease in hemoglobin in the blood;
• general weakness, dizziness.

Weight loss is planned regardless of the degree of appetite. A frequent and important symptom is bleeding with a typical clinic. Accompanying pain with an attack of vomiting.

There are more than a hundred types of benign tumors. The duration of the manifestation of education is long or short, even with significant tumor sizes. Patients diagnosed with a proliferating benign neoplasm observe progression in development. Non-epithelial is classified as single.

Reasons for development

All oncological neoplasms have manifestation factors:

1. exposure to chemical factors;
2. hereditary factor;
3. polyps become a side echo of another disease;
4. biological risks;
5. the presence of viral infections;
6. exposure to x-rays;
7. hormonal disbalance.

Classification

Among the epithelial benign neoplasms are found:

To determine the nature of the neoplasm, the following methods are used:

1. cytological;
2. histological;
3. enzyme-chemical;
4. immunocytochemistry and immunohistochemistry;
5. electron microscopic.

The attending physician should fully reflect in the history of focus on the data of morphological studies.

If the tumor was removed during surgery, you need to know within which tissue, healthy or diseased, it grew. This is necessary to establish the symptoms of the pre-tumor diagnosis and the response of the surrounding tissues.

Benign tumors of the stomach develop due to inflammatory and reactive hyperplasia of the gastric mucosa. They are distinguished more often as fibroepithelial, much less often in the form of fibromyomas, neurin, angiomas, lipomas,. Polyps are considered benign formations, can grow in multiples or be single.

Polypous formations

Signs:

• pathological signs. The classification divides the polyps according to their symptoms: gastritis, complicated by polyps, overgrown polyps in the digestive system;
• clinical signs. It is asymptomatic in gastritis anemic type. Complications - bleeding formations, their removal into the duodenum 12; combined disease of the lining of the stomach by polypous neoplasms and a cancerous region;
• distinguish polyps flat or protruding above the mucosa. The flat shape of the polyps resembles the surface of the cerebral cortex;
• pathological signs.

Establishing factors:

• general symptoms - increased fatigue and fatigue, disability, a feeling of fullness in the abdomen;
• pain sign;
• nausea, vomiting, decreased appetite, dyspeptic disorders;
• decreased gastric secretion, the presence of blood fibers in the stool, the appearance of anemia;
• x-ray indications, endoscopic results confirming the presence of a developing neoplasm in the stomach;

Diagnosis of education

Polyps in an organ mucosa represent multiple formations protruding above the mucous membrane into the cavity of the stomach. This type of neoplasm is often found. Finding and developing polyps is very dangerous for the stomach and they indicate violations in the gastrointestinal tract. They can develop into malignant tumors if they are not removed promptly.

At the beginning of the formation of the disease, polyps do not appear in any way until a certain time. This makes early diagnosis difficult. Gradually, characteristic specific pain sensations of aching and prolonged nature appear.

There is a feeling of aches in the area of \u200b\u200bthe shoulder blades and lumbar region. It is assumed that the pains are not caused by the polyps themselves, but by those changes that occur in the gastric mucosa.

Other symptoms include excessive salivation, loss of appetite, painful sensation in the pancreas, belching, heartburn, vomiting, broken stools, weakness throughout the body. Possible increase in temperature to 39 degrees.

The decisive moment in the diagnosis is the endoscopic examination. Often, in the treatment of polyps, an emergency medical intervention is performed and an operation is performed to obtain reliable information, and to take a biopsy for histology.

The diagnosis will be helped by the introduction of double contrasting of the stomach and x-ray. It will reveal the shape of the roundness of the formation and its borders, show all the defects. Ultrasound examination will give its results. It will help to differentiate the walls of the organ, its mucous membrane, introduce it to a localized formation and give data to the neoplasm - its shape, type of growth, development, and help to predict the condition of the patient.

Endoscopic examination of the stomach

Endoscopy of a benign formation will detect existing polyps on the legs, outline the symptoms of obstruction in the duodenum 12. But the most accurate diagnosis will be given by histological examination after a biopsy.

Signs of a stomach tumor

At the early stage of developing cancer education, no special symptoms are distinguished. More often the patient complain of aching pain in the abdominal region, making itself felt immediately or after eating. It may be dizziness, chronic gastritis, or stomach bleeding. The pains cause sensations, as with peptic ulcer.

Benign neoplasms form a detachment of epithelial cells, and as a result bleeding. It can be detected by a diagnosis of iron deficiency anemia. The most dangerous tumors of the intramural type, which can be accompanied by massive, life-threatening internal bleeding.

Histology data, examination, endoscopic examination, research. Benign tumors in the stomach are divided into:

1. polypous formations;
2. hyperplastic gastropathies, such as Menetrie disease, pseudolymphomas;
3. intramural formations;
4. eosinophilic gastritis, tuberculosis, syphilis, Crohn's disease, sarcoid, contributing to the development of a gastric tumor;
5. mucous cysts;
6. mixed forms.

According to the signs of neoplasm, they reach a large size, which allows them to be diagnosed by palpation. If the polyp develops on the leg, it can penetrate through the pylorus of the stomach into the duodenum 12 and cause obstruction.

Treatment

The task of doctors is to prescribe a complete treatment course, which will include:

• local removal of the neoplasm;
• resection of the organ in whole or in part;
• chemotherapeutic;
• irradiation rate.

If a tumor of a microscopic size that affects only one gastric mucosa, endoscopic removal can be applied. In addition, the tumor should not be cancerous.

Surgery solves more global issues of removing not only the organ, but also the nearby lymph nodes, to prevent the metastatic process in the regional organs. To restore patency in the digestive tract, plastic surgery is done from the small or large intestine. At the same time, the possibility of the flow of bile acid and the secretion of the pancreas into the organ should remain.

Surgery to remove swollen stomach

An “artificial” stomach also solves digestion issues and preserves nutrients for the body. But not every sick person leaves the hospital with a favorable outcome. Cancerous cell structures remain, leading to relapse and degeneration into a malignant tumor.

Immunotherapy is one of the promising areas in the treatment of neoplasms. It is able to suppress the formation of metastases and helps organs to cope with the protective function on their own. The course is conducted on the basis of natural components, because of which there are no side effects.

The immunotherapy method includes:

1. anti-cancer vaccination;
2. the introduction of antibodies into organs;
3. immunotherapy of cell structures;
4. the introduction of immunomodulators.

This is a powerful stimulating effect on the body as a whole. It causes a willingness to increase its activity, the patient's immune system. The method is especially good for patients in whom a rapid growth of the neoplasm is planned.

About nine out of ten tumors of the stomach are malignant. One tenth is a benign tumor. As a rule, they do not threaten the life of the patient and give a favorable prognosis. But it happens that some of them undergo a malignant transformation. Therefore, patients with such a diagnosis should be observed by a gastroenterologist, undergo an annual examination, treatment, and monitor their nutrition. What are the symptoms and what are the prognosis for recovery in patients?

The nature of neoplasms

Each tumor of the stomach has its own tumor growth and cell origin. Among the neoplasms of a benign nature, the vast majority are polyps. Polyps are glandular neoplasms that grow into the lumen of the stomach, with a round shape, on a thin stalk and with a wide base. According to quantitative characteristics, the concepts of single polyp and multiple (polyposis) are divided.

Histology of tumor classification:

• in muscle tissue (leiomyoma);
• submucosal layer (lipoma);
• in vessels (angioma);
• in nerve fibers (neurinoma);
• in connective tissue (fibroma).

Classification of the tumor at the location:

• the cardiac section (the section of the transition of the esophagus into the stomach);
• the cavity of the stomach;
• antrum or pyloric department (the lower section at the transition to the duodenum).

Classification of the tumor in the direction of growth:

• endogastric (into the lumen);
• exogastric (with compression on the wall from the outside);
• intramural (inside the wall).

Until now, medical science has not precisely established why normal tissues transform and turn into benign tumors. However, gastroenterologists identify several predisposing factors and conditions in which oncopathology is more likely to form:

1. Chronic gastric infection (Helicobacter pylori).
2. Inadequate treatment of gastritis.
3. History of atrophic gastritis.
4. Genetic predisposition.
5. Improper nutrition.
6. Bad habits (tobacco, alcohol).
7. Adverse environmental conditions.

Clinical signs and diagnosis

Clinical feature: benign tumors often do not give pronounced symptoms. The disease proceeds for a long time without special complaints from the patient. It may be aching or dull pain in the stomach. With the growth of the tumor, the patient complains of a constant feeling of heaviness regardless of food intake, belching, nausea, and vomiting. He noticeably loses weight regardless of the degree of appetite. He complains of weakness, drowsiness, and dizziness. Common symptoms - a pain attack accompanied by vomiting, tarry stools.

Symptoms of polyposis:

• soreness of a pulling and pressing character in the epigastric region for one to three hours after eating;
• belching with food or air;
• constant burning sensation in the sternum;
• diarrhea or constipation.

Polyposis is often complicated by hemorrhage. Minor bleeding is determined using an occult blood test in the stool.

Chronic bleeding leads to iron deficiency or hypochromic anemia.

Leiomyoma (a neoplasm of muscle tissue) usually does not give symptoms. Only when necrotic changes begin do symptoms of internal bleeding appear in the form of weakness, weight loss, and iron deficiency anemia.

To make a diagnosis of a benign tumor of the stomach, the presence of symptoms such as pain does not represent diagnostic value for the doctor, because it can accompany both peptic ulcer and gallstone disease, colitis

In general, an objective study of this disease is uninformative.

Diagnosis requires endoscopic and x-ray examination.

X-ray determines the number of polyps, size and location. With polyps, the image shows the formation of the correct form and with even outlines, with the unchanged gastric mucosa that surrounds this area.

Gastroscopy is considered more accurate than x-rays. It makes it possible to detect growths of small sizes that cannot be seen on radiography. The second advantage of endoscopy: the possibility of taking biopsy material for morphological examination.

Crucial in the diagnosis is a comprehensive examination (X-ray, endoscopy with targeted biopsy and cytology).

Therapy

Surgical treatment of benign neoplasms.

The treatment of polyps is to remove them with a gastroscope. During the diagnostic procedure of esophagogastroduodenoscopy, after assessing the state of the digestive system with an endoscope, the surgeon excises either the neoplasm itself or the tumor body with part of the gastric wall. After

tissue excisions are urgently sent to the laboratory for histological analysis.

Treatment of diffuse polyposis is also surgical. Only in this case is a gastrectomy performed (complete removal of the stomach).

After surgical treatment with excision has been performed, medications are prescribed:

• drugs that reduce the production of hydrochloric acid;
• with infection Helicobacter pylori antibacterial treatment is indicated.

The prognosis for the disease is relatively favorable. From the moment the diagnosis is confirmed, the patient is put on a dispensary record with a mandatory annual full examination. As a preventive measure for the development of benign tumors, you should get rid of bad habits, eat only healthy food and treat gastritis in time.

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Abstract of dissertationon medicine on the topic Non-epithelial tumors of the stomach. Diagnostics and treatment tactics

As a manuscript

DUBININ Sergey Anatolyevich

Non-epithelial tumors of the stomach.

DIAGNOSTICS AND MEDICINAL TACTICS. 14.00.27 - surgery

MOSCOW - 1997

Work is done

at the A.V. Vishnevsky Institute of Surgery RAMS and Moscow City Oncology Center.

SCIENTIFIC MANAGERS:

Laureate of the State Prize of the Russian Federation,

doctor of Medical Sciences, Professor KUBYSHKIN V. A.

Doctor of Medical Sciences CHKHIKVADZE V.D.

OFFICIAL OPPONENTS:

Doctor of Medical Sciences, Professor PETROV V.P. Doctor of Medical Sciences, Professor PATYUTKO Yu. I.

Leading Organization -

Moscow Cancer Research Institute P.A. Herzen.

Protection will take place "£" 4997 g

at the clock at the meeting of the Dissertation Council D.001.19.01. at the A.V. Vishnevsky Institute of Surgery RAMS at: 113811, Moscow, B. Serpukhovskaya St., 27, conference room.

The dissertation can be found in the library of the Institute of Surgery. A.V. Vishnevsky RAMS.

Scientific Secretary of the Candidate Dissertation Council. honey. of sciences

Shulgina N. IV

TOPICALITY OF THE PROBLEM

Non-epithelial tumors of the stomach (KNIFE) are a relatively rare disease of the digestive tract. Among tumor lesions of the stomach, they are observed in 0.5-5% (Gashelin S. A., 1995, Lebedev V. A., 1991, Ponomarev A. A., 1996, Dougherty M. J., 1991, Fischbach W., 1992). The disease can be asymptomatic with a significant size of the neoplasm and be accompanied by severe clinical symptoms at a small size if it occurs in the sphincter zones of the stomach. Therefore, the rarity of this disease, on the one hand, and the multiplicity of its manifestations, on the other hand, determine the complexity of diagnosis and, often, the late detection of a tumor.

A lot of works of both domestic and foreign authors have been devoted to the diagnosis and surgical treatment of patients with VA. However, the analysis of modern literature data has shown that a number of issues are insufficiently covered: the most informative complex of modern diagnostic methods has not been determined, which allows substantiating treatment tactics, there are conflicting judgments in the choice of method and the volume of surgical treatment.

The complexity of the diagnosis can be reduced due to the introduction into clinical practice of such highly informative non-invasive instrumental methods as ultrasound, computed tomography, angiography (Roslov A. L., 1992, Ferrozzi F., 1993, Lerner M., 1992, Palazzo L., 1993) . However, in modern literature, the role of these techniques in VA is practically not reflected, as a result of which the latter are often not used in patients with VA.

The need for surgical treatment of these patients is currently beyond doubt. However, the dispute

the questions of choosing the nature and scope of surgical treatment, both benign and malignant, remain. (Petrov V.P., 1993, Rath M. 1994, Shutze W. R., 1991). So, there is no consensus on the volume of surgical intervention for lymphosarcoma of the stomach, the need for palliative resection of the stomach in this disease (Bandoh T., 1993, Walker K., 1992). For other varieties of gastric sarcomas, alternative opinions also exist. Some authors recommend performing gastrectomy or subtotal resection of the stomach (Laletin V.G., 1991, Sobrino-Cossio S., 1995). Other experts believe that the effectiveness of gastrectomy and wedge-shaped resection of the stomach with these types of VA is the same (Carson W., 1994, Conlon K. S., 1995, Farrugia G., 1992). The issue of the eligibility of organ-saving operations in benign non-epithelial neoplasms also needs to be resolved.

It should be noted that the analysis of the results of various methods of surgical treatment of VAW in most authors is based on a small number of observations, which does not allow to make reasoned conclusions. Therefore, of great scientific and practical interest is the study of the long-term results of treatment of patients with VAW, the impact on the survival of patients with tumor characteristics (morphology of the tumor, its size, prevalence of the tumor process, invasion into other organs, the presence of metastases). But, undoubtedly, one of the most important tasks is to establish the effect on the prognosis of the disease of the nature and volume of the operation performed and to determine the value of combination therapy in the treatment of VAW. This work is aimed at solving these issues.

PURPOSE OF THE STUDY

To develop an optimal diagnostic system and pathogenetically sound choice of surgical tactics for non-epithelial tumors of the stomach.

RESEARCH OBJECTIVES

1. To substantiate the optimal complex of diagnostic studies in patients with non-epithelial tumors of the stomach, to establish the factors and conditions that determine their early diagnosis.

2. To substantiate the criteria for the selection of therapeutic tactics and methods of surgical treatment for morphologically different non-epithelial tumors of the stomach.

3. To evaluate the effectiveness of the results of surgical treatment of non-epithelial tumors of the stomach based on the analysis of its immediate and long-term results.

4. Determine the place of combination therapy in the treatment of non-epithelial tumors of the stomach.

SCIENTIFIC NOVELTY

1. The set of clinical symptoms and diagnostic criteria has been determined, which allows, prior to surgery, to more likely establish the nature of non-epithelial tumor of the stomach.

2. The role is specified and the practical value of modern instrumental (ultrasound, CT) research methods in the diagnosis of non-epithelial tumors of the stomach and the rational sequence of their use are determined.

3. An assessment of various therapeutic tactics in the light of predicting the course and outcomes of the disease is presented.

4. The principles of choosing the optimal therapeutic tactics for various morphological varieties of non-epithelial tumors of the stomach are substantiated.

5. Using the methods of mathematical statistics, factors that determine the prognosis and course of the disease are identified.

PRACTICAL VALUE

1. The general patterns of clinical manifestations of non-epithelial tumors of the stomach are described in detail.

2. An optimal system of instrumental diagnostics has been developed for non-epithelial tumors of the stomach.

3. Criteria for the selection of medical tactics, methods of surgical and combined treatment have been developed.

APPROVATION OF WORK

The main provisions of the work reported at the conference of the Department of Abdominal Surgery at the Institute of Surgery. A.V. Vishnevsky June 26, 1997.

SCOPE AND STRUCTURE OF WORK

The thesis is built according to the traditional type, consists of an introduction, a literature review, 4 chapters of our own studies based on the analysis and observations of 82 patients with non-epithelial tumors of the stomach. Contains 14 tables, 10 photos and 4 graphics. The bibliography is represented by 81 works of domestic and 86 foreign authors. The volume of the dissertation is 158 typewritten sheets.

BASIC INFORMATION ABOUT THE RESEARCH AND ITS RESULTS

The experience of the Institute of Surgery named after A.V. Vishnevsky RAMS and Moscow City Oncology Center, where from 1977 to 1997, inclusive, 82 patients were treated for non-epithelial tumors of the stomach (VA), including 38 patients with benign non-epithelial tumors of the stomach (IDA). (women - 28, men - 10), with malignant non-epithelial tumors of the stomach (ZNOZH) - 44 patients (women - 18, men - 26).

The frequency of individual varieties of VAWs in our study was significantly different. Among benign neoplasms, leiomyomas predominated, which were detected in almost half of patients (45%). They were followed by glomic tumors (13.5%), lipomas (10.5%) and angioliomyomas (10.5%). The remaining varieties of DNES were represented by single observations.

The first place among malignant neoplasms of the stomach was occupied by lymphosarcomas (66%). The remaining morphological varieties of ZNOZh were revealed much less frequently: angioliomyosarcoma - 20.5%, leiomyo-sarcoma - 9%, malignant glomic tumor - 4.5%.

By the incidence of VLAD, women suffered from them almost three times more often than men. We have not seen hamart, fibromyomas, angioleiomas and neurogenic tumors in males. Lipomas, fibromas and glomic tumors were detected with approximately the same frequency in both men and women.

Malignant neoplasms were deliberately distributed by us into two groups: stomach lymphosarcomas and other types of malignant non-epithelial neoplasms. This grading, in our deep conviction, is absolutely necessary in view of the identified

various clinical manifestations, the course of the disease and the tactics of surgical treatment of these tumors.

Sarcomatous lesion of the stomach in men was almost one and a half times higher than in women. The same ratio was found both with lymphosarcoma of the stomach, and with other varieties of GnR.

A study of the age-related characteristics of patients with ACID showed that the peak incidence occurred at the age of 50-70 years, which was detected in two thirds of our patients (66%). It should be noted that while the maximum incidence among women was observed in the life period of 50-69 years (78.7%), in men it was over the age of 70 years (40%).

Malignant non-epithelial neoplasms prevailed in people of both sexes aged 40-49 years, which was detected in 36% of cases. A little less often, the VALVE was found in the life period of 60-69 years (20%) and 50-59 years (18%). When analyzing the age-related characteristics of patients with lymphosarcoma, two peaks of incidence were revealed

40-49 and 60-69 years.

The localization of non-epithelial neoplasms was very different, however, the stomach body was significantly more often affected by both benign and malignant tumors.

With AFL, this was observed in almost two-thirds of patients (63%), more often a tumor was detected in the upper and middle third of the body of the stomach. In the exit section, DNOS were noted in every fifth patient, in the proximal section

Every seventh patient. Tumor localization along the anterior and posterior walls of the stomach was noted in the same number of observations - 29%, somewhat less often with great curvature - 23.5% and with lesser curvature - 18.5%. One of the features of the localization of DNOGs with different morphological structures was the fact that 75% of cases revealed gastric lipomas in the output section on the posterior wall.

Sarcomatous lesions of the stomach body were detected in more than half of our patients (54%). Day off

Table 1.

MORPHOLOGICAL VARIETIES OF NONEPITELIAL TUMORS OF THE STOMACH

Benign Malignant

Histological coli - Histological coli -

building honest-% building honest-%

tumors in tumors in

leiomyoma 17 45 lymphosarcoma 29 66

glomic 5 13.5 angioleiomyo-9 20.5

sarcoma tumor

lipoma 4 10.5 leiomyosarcoma 4 9

angioliomyoma 4 10.5 malignant 2 4.5

fibroma 3 8 glomic

hamartoma 2 5 tumor

fibromyoma 1 2.5

neurineoma 1 2.5

neurofibroma 1 2.5

TOTAL 38 100 TOTAL 44 100

cases was involved in the tumor process in every fourth patient, the proximal section and the angle of the stomach in every tenth patient.

It would be unfair not to notice the important features in the localization of malignant neoplasms for the selected groups of ZNOZH (lymphosarcomas and other varieties of ZNOZH), where heterogeneity of the gastric lesion was revealed in these diseases.

Suffice it to say that in every third patient with a VLAD, the tumor spread to two or more anatomical parts of the stomach, and in the vast majority of cases they were represented by lymphosarcoma. There is no doubt that gastric lymphosarcoma is most prone to local spread of the tumor process. So, a total lesion of the stomach by a tumor and its spread to the esophagus or duodenum was noted exclusively in lymphosarcoma. One of the main features of mesenchymal, vascular and neurogenic ZNOZH was their localization in one,

sometimes, with a significant size of the neoplasm, in two anatomical sections of the stomach.

Benign neoplasms in half of the cases had an exogastric type of growth, tumors with an intramural type of growth were found more rarely in one third of our patients and most rarely with endogastric in only one in seven patients. Tumors with an intramural arrangement in all cases did not exceed a size of 3 cm. In general, the size of the AFL varied widely. Most often, we detected neoplasms of a small size (1-3 cm) - in a third of our patients. Giant tumors (larger than 10 cm) were detected in every seventh patient.

Malignant neoplasms in most cases had an intramural type of growth (61.5%). An exogastric type of growth was noted by us in a third of patients, endogastric - in single observations. At the same time, it should be noted that intramural growth was detected in 89% of patients with gastric lymphosarcoma. Other varieties of ZNOZH had, as a rule, in our study an exogastric type of growth. So, for example, all the angioliomyosarcomas we observed were located exogastrally.

The size of the SADV varied widely. At the same time, lymphosarcomas often occupied two or more anatomical parts of the stomach, passing from one curvature to the wall or circularly covering an organ. Other types of gastric sarcomas, as a rule, grew in solitary nodes, while reaching significant sizes. The largest number of ZNOZH had dimensions of 10 cm or more, which was revealed in a third of patients. The size of angioliomyosarcomas in only one in four patients was less than 10 cm. It is noteworthy that leiomyosarcomas were characterized by a small size, in all cases their size did not exceed 5 cm, which was a considerable difficulty in the diagnosis and differential diagnosis. Thus, according to our data, the tumor size cannot be taken in

attention as a criterion of benign or malignant neoplasms.

The data presented show that the location of the tumor, its size and type of growth are random in all varieties of VAW. Lymphosarcoma is characterized by intramural growth, local tumor spread. Other varieties of ZNOZ are in most cases solitary neoplasms of a significant size and have exogastric growth. External similarity with the latest benign KNIFE does not allow to visually determine the nature of the neoplasm.

Non-epithelial tumors of the stomach

The difficulty in the early detection of both benign and malignant KNIFE is often based on their asymptomatic development, as well as the polymorphism of symptoms depending on the size, location and nature of growth. In turn, none of these factors alone reflects on the morphological affiliation of the tumor.

Therefore, in our opinion, it is practically impossible to rely on clinical manifestations in the formation of a presumptive diagnosis.

The clinical manifestations of VAW were determined not only by the nature of the growth, localization of the tumor, its size, but also by concomitant diseases of the stomach. To confirm this, consider the role of individual symptoms in the diagnosis of KNIFE.

Analyzing the clinical manifestations, we found that an absolutely asymptomatic course of the disease was observed in every seventh of our patients with IDL and tenth of the patient with IDL.

In half the cases, the most common symptoms of AFL patients were epigastric pain,

dyspeptic symptoms, general weakness. A third of our patients complained of a feeling of heaviness in the epigastric region. An objective examination sometimes made it possible to determine the presence of a palpable tumor-like neoplasm, which was detected in 16.5% of patients. Weight loss and vomiting were noted in every tenth patient with AFF. An atypical manifestation of the disease (gastric bleeding) was noted in 5% of patients.

The most common clinical symptoms in ZNO patients were general weakness (77%), epigastric pain (73%), weight loss (54.5%), dyspeptic symptoms (50%), and a feeling of heaviness in the epigastric region (32%). Symptoms such as vomiting (16%), decreased appetite (11.5%), and increased body temperature (4.5%) were somewhat less common. The first manifestation of the disease in 18% of patients was the presence of a palpable tumor in the abdominal cavity, and in all patients the tumors had an exogastric growth type. Complications (gastric bleeding) as the first manifestation of the disease were noted in 13.5% of our patients.

The above data conclusively prove that the clinical symptoms of both DENID and DREAM are identical and quite obviously coincide with the symptoms of any other stomach disease.

Therefore, with KNIFE, the disease often proceeds under the "clinical masks" of other diseases of the stomach, which was noted in 10.5% of our patients with VAD. In 3 cases, a combination of cancer and gastric leiomyoma was revealed, and in another leiomyoma and hepatocellular cancer. In all cases, MNE was detected intraoperatively and their size did not exceed 2.5-3 cm. In addition, it should be noted that in 8% of cases in patients with MNE, a history of gastric ulcer was noted, in 16% - duodenal ulcer, in 32% - chronic gastritis, 5% - polyps of the stomach.

In a third of cases in patients with ZNOZ, there was a history of gastric ulcer, and all patients subsequently had lymphosarcoma. Every de

the fifth patient suffered from duodenal ulcer. In 27% of cases, patients were previously diagnosed with chronic gastritis. Three patients were previously operated on for gastric ulcer; everyone underwent a resection of the stomach.

We have identified some patterns of clinical manifestations of the disease, depending on the type of tumor growth.

In endogastric and intramural forms of growth, the clinical manifestation of VAW included: pain in the epi-gastric region, nausea, vomiting, heartburn, belching with air, a feeling of heaviness in the epigastric region. The complaints described above were also characteristic of small neoplasms. With an exogastric location of the VA, characteristic complaints were general disorders and the presence of a palpable formation in the abdominal cavity. These complaints were also noted by patients in whom the tumor reached a significant size. At the same time, the inconsistency of the tumor size and clinical manifestations (low-symptom course) in some cases of ACID was noteworthy.

Exogastric and intramurally located KNFs were asymptomatic in approximately the same number of cases, while endogastrally located sarcomas did not have such a course of the disease in any case.

One of the main features of the clinic of mesenchymal, vascular and neurogenic sarcomas is that they appear much later than lymphosarcoma and are often manifested by various kinds of complications. So stomach lymphosarcomas in 7% were manifested by gastric bleeding, in 7% they were asymptomatic. For other types of sarcomas, an asymptomatic course was characteristic in 20%, and the development of complications in 27%.

The clinical picture of the disease in patients with ZNO also depended on the location of the tumor. So, with the location of the VW in the output section of the stomach in 30% of cases

patients complained of vomiting and 70% of nausea. As regards the feature under consideration with respect to DNOG, no similar patterns have been identified.

Summarizing our data, we can conclude that all non-epithelial tumors of the stomach, do not have a pathognomonic symptom complex, are often asymptomatic, which often does not allow us to suggest the true nature of the disease based on some patient complaints, and even more accurately differentiate the benign or malignant process. Therefore, absolutely in all patients it is necessary to conduct an examination involving all methods of instrumental diagnostics. Only such an approach makes it possible to choose an adequate treatment.

DIAGNOSTICS

Non-epithelial tumors of the stomach

The complex of diagnostic research methods included an X-ray examination of the upper gastrointestinal tract, esophagogastroduodenoscopy with gastrobiopsy, ultrasound examination of the abdominal organs, computed tomography of the abdominal organs with stomach contrast, which were performed in the vast majority of patients. In some cases, diagnostic laparoscopy and duplex scanning of the vessels of the abdominal cavity were used.

ROLE OF ESOPHAGOSTRODUODENOSCOPY

IN DIAGNOSTICS

Non-epithelial tumors of the stomach

The characteristic signs of endoscopic hypertrophy in patients with AFL were the identification of a submucosally located formation of round or oval shape, with a smooth surface

thyu, with a stretched, atrophic and thinned mucous membrane above it, in some cases with ulceration. With small neoplasms (up to 3 cm), peristalsis over the latter was not changed. In a third of cases, atrophic gastritis was detected.

An important part of the endoscopic examination was a targeted biopsy followed by histological and cytological examination, which was performed in half of our patients. As a result of this study, VID was detected in a quarter of patients (26.5%). In three cases, gastric cancer was detected, which corresponded to reality, since subsequently a combination of cancer and gastric leukomyoma was detected intraoperatively.

In an endoscopic examination of patients with VAD, a true diagnosis was made in almost two thirds of our patients (62.5%). A false-positive diagnosis (gastric cancer, ulcerative ulcer, compression and deformity of the stomach, ulcer of the onion 12 pc) was established in one third of patients. No pathological changes were detected in one observation with an exogastrally located gastric leiomyoma 1x2 cm in size. In endoscopic examination of patients with gastric lymphosarcoma, we consider the mucous membrane infiltration revealed by us in two thirds of patients (65.5%), while in a third of observations it passed from one wall of the organ to the curvature and the other wall, and every fifth patient was circular. The spread of the tumor to the esophagus was detected in two patients, and in one of them it was found that the tumor also passes to the duodenum. In 69% of cases, the presence of deformed, thickened, convoluted, edematous folds of the gastric mucosa was revealed. Peristalsis in the infiltration zone was changed in almost half of the patients (41.5%), and in one case the latter was absent. Ulceration of the gastric mucosa was detected in 38% of patients, while in the vast majority of cases they were multiple. Gastro

a biopsy in these patients revealed gastric lymphosarcoma in only 20.5% of cases.

For other types of gastric sarcomas, the following pathological changes were characteristic: visually they were rounded, oval or polycyclic, submucosally located neoplasms protruding into the lumen of the stomach in 82% of cases. Compression of the stomach from the outside was revealed in 18%. The surface of the formations in most cases was uneven, tuberous, covered with a thinned, atrophic mucous membrane, and ulceration of an irregular shape with uneven, raised edges was revealed in almost half of the cases (45%) in the apical part of the tumor. With gastrobiopsy, a diagnosis of ZNOG was established in 40% of patients.

At the same time, as our experience shows, often these varieties of ZNOZH with endoscopy with gastrobiopsy cannot be differentiated from DONZH. Therefore, the final answer can be obtained only after a histological examination of the removed neoplasm.

In the analysis of our results, it was found that endoscopy and biopsy are less effective in patients with lymphosarcoma (20.5%) than in other varieties of MAD (63.5%). This, apparently, can be explained by the visual similarity of gastric lymphosarcoma and the infiltrative form of gastric cancer. Therefore, in most patients with lymphosarcoma, the detected changes were interpreted as "stomach cancer."

Thus, endoscopy is a valuable, informative and integral method for diagnosing VAW.

THE ROLE OF THE X-RAY RESEARCH METHOD IN THE DIAGNOSTICS OF NON-EPITELIAL TUMORS OF THE STOMACH

The X-ray picture of VAW was primarily associated with the nature of the growth of the neoplasm.

With endogastric DNOS, intra-luminal filling defects were found, oval or round in shape, with clear, even contours in 80% of cases, half of which determined ulceration in the apical part. Tumor displacement was noted in all patients. In addition, a change in the contours of the folds of the mucous membrane of the stomach was detected in 60% of patients, an arcuate envelope of the folds of the mucous membrane of the tumor in 40% and a break in the latter with a significant amount of IDL in 20%.

With the intramural arrangement of DNOS, the characteristic signs were the presence of a persistent marginal filling defect of a small size, ulceration over the formation was detected only in every fifth patient. Tumors were mobile, motor evacuation function was not changed in any patient. In 3 patients with intramurally located leiomyoma, the x-ray picture was due to the presence of stomach cancer in them, no LID was detected.

With the exogastric arrangement of the DNES, the image was quite diverse. In those cases when the neoplasm was connected to the stomach wall with a “leg” (21%), no pathological changes were detected in some projections. With a large size ACID that was found in one third of our patients, the stomach was displaced and constricted. In 84% of cases, a marginal filling defect with sizes from 2 to 10 cm was revealed, ulceration on the apical part of the neoplasm was found in 16% of patients. In half of the observations, the folds of the gastric mucosa were smoothed out and fan-shaped diverged over the tumor. An X-ray examination in such patients often led to the idea of \u200b\u200bthe presence of an exogastrally located neoplasm or pressure on the stomach of a tumor emanating from any organ of the abdominal cavity.

The true diagnosis after performing an X-ray examination in patients with AFL was established with

endogastric, intramural and exogastric growth forms in 60%, 50% and 68%, respectively, and in all growth forms - in 60.5%.

The following pathological changes were characteristic of the X-ray examination of the upper gastrointestinal tract in patients with lymphosarcoma: filling defects 1-10 cm in size with fuzzy uneven contours and ulceration in the form of a “niche” with fuzzy uneven contours in half of the patients, local absence peristalsis - in 45% of cases, its complete absence - in two patients. Persistent deformity of the stomach was detected in a quarter of cases, infiltration of the gastric mucosa - in 79.5%, stiffness of the mucosa in the infiltration zone - in 62%. A third of our patients showed an alternation of tuberous growths of the mucous membrane with areas of atrophy and thinning of the latter.

After this study, a true diagnosis was established in only% of cases. In most cases, these changes were interpreted as gastric cancer (83%).

An X-ray examination with other forms of ZNO with an exogastric form of growth revealed 78% of cases of deformity of the stomach, filling defects of 4-8 cm with uneven fuzzy contours were identified, a change in folding in the area of \u200b\u200bthe filling defect was observed in 89%, and envelope folds in 78% mucous membrane of the tumor. Motor-vacuum function was not changed in any patient.

At the endogastric location, filling defects with fuzzy uneven contours, convergence of mucosal folds to formation and a wide tumor shaft were determined, with a local absence of peristalsis.

In the intramural form of growth, the presence of a filling defect with uneven clear contours and a local absence of peristalsis in two thirds of the patients were revealed.

An X-ray examination of mesenchymal, vascular, and neurogenic sarcomas revealed a true diagnosis in 65% of cases.

So, it should be noted that esophagogastroduodenoscopy and X-ray examination of the stomach make it possible to identify and correctly interpret the revealed changes in a sufficiently large percentage of observations of VLAD and mesenchymal, vascular and neurogenic ZNOZH. At the same time, with lymphosarcoma of the stomach, these research methods are often not enough to verify the true nature of the disease.

ROLE OF ULTRASOUND RESEARCH IN NON-EPITELIAL TUMORS OF THE STOMACH

Diagnostic difficulties can sometimes be resolved by the ultrasound diagnostic method.

The study revealed pathological formations, in 20% having a connection with the stomach, their contours ranged from clear even to clear uneven, echogenicity from hypo to hyperechoic, structure from heterogeneous to homogeneous. No dependence of the contours, structure, and echogenicity on the morphological species of LAD was revealed.

In patients with VAD, a true diagnosis was made in every fifth case. In 17%, a false-positive diagnosis of a tumor of another abdominal organ was obtained.

With lymphosarcoma, thickening of the walls of the stomach to 2-2.5 cm was visualized, with other types of ZNOZH - solid tumors associated with the stomach, a heterogeneous structure, hypoechoic, in some cases heterogeneous, with decay cavities.

The true diagnosis in patients with MAD was established in 10% of patients. In a third of cases, a false-positive diagnosis of gastric cancer was obtained (mainly with

phosarcoma) or tumors of some other abdominal organ.

The low percentage of detection of both DZN and VLW in our study can be explained by a number of reasons. Firstly, our study was screened in nature, and was not conducted for a targeted search for pathological tumors of the stomach. Secondly, we did not use any special techniques for contrasting or tight filling the stomach. Therefore, this result can be considered satisfactory.

Thus, in our opinion, traditional endoscopic, radiological, and ultrasound methods of research do not provide enough information for VA. To clarify the diagnosis of these diseases, it is necessary to use more modern examination methods, namely, computed tomography of the abdominal cavity and stomach.

COMPUTER TOMOGRAPHY

IN THE DIAGNOSIS OF NONEPITELIAL TUMORS OF THE STOMACH

The most effective method in the diagnosis of VLD is computed tomography of the abdominal cavity and stomach, which made it possible to establish the correct diagnosis in patients with VLD in most cases (83.5%).

During the study, pathological neoplasms with sizes from 2 to 12 cm, density from -112 to 40-44 units were identified, their contours varied from clear uneven to clear even ones. The structure was in some cases homogeneous (lipoma, hamartoma), in others - not homogeneous (leiomyoma, angioleioma, glomic tumor).

As our experience has shown, CT allows not only to accurately determine the organ belonging of the tumor, but also in some cases to characterize it morphologically.

With ZLOZ, computed tomography made it possible to correctly establish the diagnosis in half of the observations.

In this case, pathological formations of 6-14 cm in size were identified, in all cases with an even clear contour, in the majority (68%) they were not homogeneous, and in one third of cases, they had decay cavities.

In other cases, a false-positive diagnosis of gastric cancer (with lymphosarcoma) and a tumor of an abdominal organ (with other types of ZNOZH) was established. In addition, the undoubted role of CT in the detection of metastases in MULTIPLICA.

I would like to note that CT was more effective in the diagnosis of mesenchymal, neurogenic and vascular tumors, when in the vast majority of cases the correct diagnosis was made. The sensitivity of this method for all varieties of ZNOZH was significantly higher than for other instrumental methods of examination.

In our deep conviction, the CT method should be widely used in the diagnosis of KNIFE. To ensure greater effectiveness, the research method itself must necessarily include the maximum expansion of the walls of the stomach with the introduction of gas or water-soluble contrast.

The sequence of application of various methods of instrumental diagnostics in patients with VAW, in our opinion, should be as follows: x-ray examination of the stomach, esophagogastroduodenoscopy with hastrobiopsy, ultrasound, computed tomography. We believe that only the use of the entire set of instrumental research methods in the diagnosis of VAW allows us to get as close as possible to solving the diagnostic problem in these patients.

So, when using the entire complex of diagnostic measures, the diagnosis of DNOS was established and

the outcome coincided with a clinical diagnosis in 69% of cases. With ZNOZ, diagnostic accuracy was 30% (lymphosarcoma - 20.5%, other varieties of ZNOZ - 48%).

Table 2.

INFORMATIVITY OF METHODS

INSTRUMENTAL DIAGNOSTICS

With non-epithelial tumors of the stomach

Method for researching the number of observations the diagnostician, accuracy.

endoscopy 37 62.5% 40 32.5% lymphosarcoma - 20.5% other ZNOZH - 63.5%

X-ray examination 38 60.5% 43 25.5% lymphosarcoma-7% other ZNOZH - 65%

Ultrasound 30 20% 30 10%

CT 12 83.5% 11 54.5%

TREATMENT OF PATIENTS WITH NONEPITELIAL TUMORS OF THE STOMACH

The formation of the principles for substantiating therapeutic tactics in VAW is based on their morphological variety, localization, and size of the neoplasm.

But the fact that many patients with VAW in the preoperative period do not have a morphological

confirmation of the diagnosis or morphological diagnosis is presumptive; the need for surgical treatment in this category of patients is not in doubt.

TREATMENT OF PATIENTS WITH Benign non-epithelial tumors of the stomach

For most of our patients, DNOS (78.3%) underwent organ-saving surgeries - tumor enucleation or sphenoid resection of the stomach. An urgent histological examination revealed the benign nature of the disease, the absence of tumor cells in the section of the removed part of the stomach. An analysis of the immediate and long-term results of the treatment showed that no relapse of the tumor was detected in any case. All this allows us to consider organo-saving operations as the operation of choice in the case of DNA.

At the same time, the surgeon should not be misled by the appearance or size of the neoplasm. In those cases (21.7%), when it was impossible to reliably exclude malignancy, as well as when a large tumor was localized in the antrum or when a combination of DNOS with an epithelial tumor was performed, a stomach resection in an oncologically substantiated volume should be performed.

In one observation, an operation was performed for endoscopic removal of an endogastrally located ACID. Given the absence of a large number of such observations, it is not possible to unequivocally say "for" or "against" such operations.

In the immediate postoperative period, no complications were revealed in patients with ATLD in the vast majority of patients. One patient was diagnosed with gastric bleeding and the other ana

stomosit and violation of evacuation. Conservative treatment in both cases led to recovery. In another observation, an eventration in the area of \u200b\u200ba postoperative wound was revealed, and a postoperative wound was sutured. Finally, in the fourth patient, an esophageal-gastric anastomosis was revealed after proximal subtotal gastrectomy for leiomyoma and gastric cancer, the patient died.

TREATMENT OF PATIENTS WITH MALIGNANT NONEPITELIAN TUMOR TUMORS

In case of gastric lymphosarcoma, depending on its location and size, we performed subtotal gastrectomy or gastrectomy, which were performed in our patients, respectively, in 67% and 22.2% of cases. Moreover, it was revealed that regional lymph nodes were affected by this disease in 52% of our patients and the tumor spread to two or more anatomical parts of the stomach in 37% of cases. In every seventh patient, when the adjacent abdominal organs were involved in the tumor, the operation was expanded to completely remove the neoplasm.

Analysis of the immediate and long-term results of surgical treatment of these patients showed that subtotal gastrectomy and gastrectomy are an adequate intervention for gastric lymphosarcoma.

We believe that in these patients, when radical surgery is impossible due to the presence of regional and distant metastases, it is advisable to perform palliative gastric resection with subsequent chemotherapy. According to our data, such tactics ensured a median survival of 80.7 months and an actual survival.

54.5%. The reason for rejecting the latter can only be a high degree of operational risk. In this case, we recommend polychemotherapy as the only treatment.

Complications in the immediate postoperative period were observed in 29% of patients (postoperative pneumonia, suppuration of the postoperative wound, puncture pneumothorax). In all cases, conservative treatment led to the recovery of patients. Failure of esophagoejunoanastomosis, bilateral pneumonia with abscess formation and pulmonary edema, necrosis of the wall of the stomach stump caused the death of 3 patients. Thus, mortality in the immediate postoperative period of patients with lymphosarcoma was 11%.

Conducting chemotherapy treatment in a number of patients in the postoperative period made it possible to achieve long-term remission in a number of patients. Polychemotherapy in the immediate postoperative period in an amount of 4 to 8 courses was performed in every fourth patient, who was prescribed at the slightest doubt about the radical nature of the operation.

Based on our experience, the treatment of patients with gastric lymphosarcoma should be comprehensive and include surgical intervention with mandatory postoperative polychemotherapy.

In other varieties of gastric sarcoma, a rare local regional and metastatic spread, which was shown by an analysis of the long-term results of surgical treatment, allows wedge-shaped gastrectomy, which was performed in 53% of patients. Due to the spread of the tumor to neighboring organs (40%), it was often necessary to supplement the operation with a resection of the abdominal organ involved in the tumor process. In 37% of cases, subtotal gastrectomy was performed.

Postoperative complications in patients with mesenchymal, vascular and neurogenic ZNOZH were noted in every seventh observation (postoperative

pneumonia, pancreatic necrosis). Conservative treatment in all patients led to recovery.

Mortality in the immediate postoperative period for all varieties of ZNOZH was 7.1%. ZNOS turned out to be resectable in 78.5% of cases, palliative operations were performed in 16.5%.

LONG-TERM RESULTS OF SURGICAL AND COMBINED TREATMENT OF PATIENTS WITH NONEPITELIAN

TUMOR OF THE STOMACH

When analyzing the long-term results of surgical treatment of patients with VAW, we used the methods of statistical processing of SZB: 81izys (81a1Bo11.1991). A study of the long-term results of treatment of 73 patients with VAW was carried out, the information about which was available to us by 1997 (DNOZH-36, ZNOZH-37). 5 patients were lost for remote observation.

Of the patients with gastric lymphosarcoma in the distant period, 39% of patients died from the underlying disease. Acturial 3-year survival of patients with lymphosarcoma was 81% in our patients, 5-year-old - 50%, 10-year-old - 12%.

Among our patients with other types of VAD, in the long term 28.5% of patients died from the underlying disease. Actural 3-year survival in these patients was 50%, 5-year-old - 30%, 10-year-old - 10%.

It was statistically significant that the survival of patients with lymphosarcoma is higher than with other types of ZNOZH (p< 0,05).

An analysis of the long-term results of surgical treatment of patients with IDA revealed that in no case was the cause of death associated with the underlying disease.

We have information about the high statistical significance of the adverse effect on the prognosis of the disease in patients with VAD, infiltration of the entire thickness of the stomach wall, invasion of adjacent abdominal organs, the spread of the tumor into two or more anatomical parts of the abdominal cavity, the size of the tumor is more than 7 cm, and the presence regional and distant metastases. The prevalence of the tumor process and the presence of metastases are undoubtedly more important for the prognosis of the disease than other factors (p< 0,05).

The best results for lymphosarcoma of the stomach are the subtotal resection of the stomach or, if necessary, gastrectomy. With other types of ZNOZH, the survival of patients was identical with both sphenoid and subtotal resection of the stomach. Significantly increases the survival of patients with lymphosarcoma after chemotherapy in the postoperative period, which allowed to increase the 5-year survival of patients from 28% to 66% (p< 0,05). Итоги изучения отдаленных результатов хирургического лечения больных ДНОЖ указали на высокую эффективность малотравматичных экономных, органосберегающих операций.

1. Non-epithelial tumors of the stomach (KNIFE) do not have a pathognomonic symptom complex, are often asymptomatic or are characterized by a variety of clinical manifestations depending on the location, size of the neoplasm, nature of growth and morphology. For the diagnosis of KNIFE, it is necessary to use the whole complex of modern methods for examining the stomach, among which computed tomography is the most diagnostically informative.

2. From the standpoint of evaluating the immediate and long-term results of the operation of choice for benign non-epithelial tumors, organ-saving operations are advisable - enucleation of the tumor or wedge-shaped resection of the stomach with an urgent histological examination. If it is impossible to exclude malignancy, resections of the stomach in an oncologically substantiated volume should be performed.

3. The volume of surgical intervention for malignant non-epithelial tumors of the stomach largely depends on the nature of the tumor. With lymphosarcoma of the stomach, depending on its size and localization, subtotal resection or gastrectomy is adequate. In the presence of unredeemed regional and distant metastases and the impossibility of radical surgery, palliative resection of the stomach is advisable. A rare locally-noregional and metastatic spread in other sarcoma species allows for wedge-shaped gastrectomy.

4. After removal of gastric lymphosarcoma, polychemotherapy is indicated in all cases, which significantly increases the 5-year survival of patients.

5. The prognosis for benign neoplasms is favorable. For all types of gastric sarcomas, adverse factors worsening prognosis of disease-28

these are the infiltration of all layers of the stomach wall, the size of the tumor is more than 7 cm and, to the greatest extent, the presence of metastases and the spread of the tumor to more than one anatomical section of the stomach.

1. Symptoms of non-epithelial tumors of the stomach are always non-specific, do not have clear manifestations. If there is a suspicion of the patient having an epithelial tumor of the stomach, early involvement of a comprehensive diagnostic program, including all modern methods of instrumental diagnostics, is necessary.

2. In the diagnosis of VAW, it should be taken into account that only the complex of methods has the highest diagnostic sensitivity, including X-ray examination of the stomach, esophagogastroduodenoscopy with gastrobiopsy, ultrasound, computed tomography of the abdominal cavity and stomach.

3. In operations for benign non-epithelial tumors of the stomach, the implementation of organ-saving interventions is indicated - enucleation of the neoplasm or wedge-shaped resection of the stomach. The benign nature of the tumor must necessarily be confirmed by an urgent histological examination of the surgical material.

4. In operations for lymphosarcoma of the stomach, it is necessary to perform subtotal resection or gastrectomy, with other varieties of GRA, it is permissible to perform a wedge-shaped resection of the stomach.

5. In the postoperative period, all patients with gastric lymphopharcoma are shown to undergo polychemotherapy.

1. "Treatment of non-epithelial tumors of the stomach" / abstract of the International Conference of the 8th Congress of Surgeons of the Republic of Moldova "Actual Issues of Thoracoabdominal Surgery", Chisinau, 1997 / et al. V.A. Kubyshkin, V.D. Chkhikvadze, I.P. Kolganova.

2. "Clinic, diagnosis and treatment of benign non-epithelial tumors of the stomach" 1997. Soavt. V. A. Kubyshkin, G. G. Karmazanovsky, K. D. Budaev, I. P. Kolganova (accepted).

Fibroma has the structure of mature connective tissue, with the only difference being that bundles of collagen fibers of various thicknesses are randomly located and there is an unusual ratio of cells and fibers. With a predominance of cellular substance and a loose arrangement of collagen fibers, fibroids have a soft consistency and are called soft. The predominance of collagen fibers, represented by powerful bundles with areas of hyalinosis, causes a high tumor density - dense fibromas. These tumors have a whitish color, sometimes with a yellow tint.

In the stomach and duodenum, fibroids are very rare. By 1942, there were reports in the literature of 91 gastric fibroids, of which 25 belonged to domestic authors (A.V. Melnikov). A.F. Chernousoe et al. (1974) consider that fibromas make up about 5% of benign mesenchymal tumors of the stomach. According to statistics by N. S. Timofeev, fibromas are more common and make up 11.7% in relation to all benign tumors of the stomach. In our country, the first operation for gastric fibroma in 1926 was performed by V. A. Oppel. We could not find descriptions of duodenal fibroma.

Fibromas originate in the submucosal layer of the stomach, are most often localized on the back wall of the pyloric department, have a wide base. Fibromas can grow exogastrally, and then they often have a stalk and reach large sizes, as was the observation of M.D. They grow slowly, sizes vary widely. In a patient described by M. D. Sharano, fibroma weighed 5.5 kg. The form of fibroids is round, oval or pear-shaped. More often there are single, but cases of multiple fibroids of the stomach are described. As the tumor grows, it narrows the lumen of the stomach, and if it is elongated or pear-shaped, it can shift into the duodenum. Fibromas are not prone to ulceration and bleeding, but they can give rise to malignant growth. According to 3. I. Kartashev (1938), fibrosarcomas make up 4.4% in relation to other forms of gastric sarcomas. I. S. Rozhek (1959) described fibroma combined with primarily multiple gastric cancer.

Slow tumor growth, round shape, dense or (less often) soft consistency, little effect on the wall of the stomach cause a long asymptomatic course of the disease. As fibroids increase, a feeling of heaviness or overflow of the stomach after eating more clearly emerges, pains in epigastrium, loss of appetite appear. With significant sizes, the tumor becomes accessible palpation. Localization of the tumor near the pylorus gives a clinical picture of gradually increasing stenosis, and the possible sudden closure of the exit from the stomach or pinching of the fibroma by the pylorus - a picture of acute obstruction: severe pain, repeated vomiting, restless behavior, etc. Clinic of gastric fibroma moving into the lumen of the duodenum, described by I. A. Shanurenko (1935) in one of the first messages in Russian literature.

Roentgenogram. Fibroma of the stomach

Diagnosis of gastric fibroids, as well as other non-epithelial tumors, presents significant difficulties. They are sometimes found on the operating table during operations undertaken for another reason. A feeling of heaviness after eating, a decrease in appetite, pain in the epigastric region, symptoms of non-ulcer pyloric stenosis induce the doctor to think primarily about stomach cancer. An objective study is valuable only when through a thin abdominal wall it will be possible to probe a dense, non-painful, shifting tumor of a round shape. This suggests a benign tumor of the stomach. As with other diseases of the stomach, a decisive role in the diagnosis of fibromas is played by an X-ray examination, which detects a rounded filling defect with clear contours (Fig. 11). A description of the exact radiological diagnosis of gastric fibroma is given by S. A. Reinberg (1927).

The use of fiberscopes makes the recognition of gastric fibroids real, but one should not forget about the difficulties of differential diagnosis with sarcoma.

With small fibromas, its removal by excision of the wall of the stomach is permissible. Doubt in the diagnosis and large fibroids require resection of the stomach, and with suspected malignancy - with the removal of large and small epiploons. Indications for gastrectomy are multiple fibromas.

Today it is very difficult to find a person who does not suffer from diseases of the stomach, and gastritis is considered a normal component of the life of almost everyone living in a metropolis. We are so accustomed that in the conditions of the modern world it is very difficult to maintain a balance of a healthy diet that we let the stomach problems drift, which can subsequently lead to very sad consequences, because almost 95% of the tumors of the stomach are malignant, and the disease itself is in second place after lung cancer.

In the modern world, men are more exposed to this disease than women, especially the risk increases after reaching 45 years. Recently, there has been a slight wave of decline in disease statistics, but it is too early to talk about the complete absence of danger.

Classification of tumors of the stomach

Depending on the type of tissue from which the tumor appeared, they are divided into benign and malignant - this classification not only tells us about the danger of neoplasm, but also indicates the main place of the onset of inflammation.

A benign tumor of the stomach is a polyp, a glandular formation that has a round shape. There is also a quantitative classification:

• Single polyps;
• Multiple polyps;
• Polyposis.

Classification of the structure of polyps:

• Adematous - with a size of more than fifteen millimeters, they are converted into a tumor.
• Hyperplastic - develop in connection with atrophic gastritis.
• Inflammatory-connective tissue tumors are not.

There is also a classification of tissues from which a benign neoplasm can occur:

1. muscle (leiomyoma);
2. submucosal layer (lipoma);
3. blood vessels (angioma);
4. nerve fibers (neurinoma);
5. connective tissue (fibroma).

The classification of gastric tumors also includes malignant tumors. Most of these neoplasms are of epithelial origin. Gastrointestinal stromal tumor of the stomach is also a malignant formation, although it makes up only one percent of the total number of cases. Other tumors include:

• carcinoid - a tumor is capable of producing hormones;
• leiomyoblastic tumor - contains epithelial and smooth muscle cells;
• leiomyosarcoma - matted smooth muscle cells.

The main causes

Epithelial cells located on the inner wall of the gastric tract are a common site of tumor. Cancer can develop in any of the gastric departments:

1. main or middle departments;
2. on the border with the esophagus - the upper section;
3. on the border with the intestine - the lower section.

As in other areas of oncological abnormalities, scientists were unable to identify the exact time and cause of the cell mutation, which as a result leads to the onset of a tumor. However, scientists were able to find out what events precede the onset of tumor formation. In a healthy stomach, a neoplasm cannot develop, and therefore there must be reasons that lead to a change in the gastric composition.

Of the well-known reasons, the following classification can be made:

• heredity: stomach ulcer, polyps, gastritis (with low acidity);
• the use of products that provoke the appearance of gastric diseases: smoked, spicy, fried. This also includes drinking alcohol, smoking;
• the presence in the stomach of the bacterium helicobacter pylori;
• low levels of vitamins B12 and C can also cause gastric cancer.

Signs of a stomach tumor

The main problem in identifying this terrible disease is that in the initial stages of the appearance, the symptoms are very similar to ordinary gastritis, which prompts doctors to determine this particular diagnosis and prescribe the wrong treatment.

Sudden changes or pains at the initial stage of a tumor of the stomach are not observed, however after a while the patient begins to experience all the inherent symptoms of a tumor:

1. fatigue;
2. apathy;
3. lack of appetite;
4. depression;
5. pallor of the skin;
6. sharp weight loss;
7. possible development of pernicious anemia.

A stomach tumor, the symptoms of which are listed above, is also accompanied by unpleasant sensations in the esophagus itself: there is a feeling of overeating and heaviness even after a small portion of food, the patient experiences nausea, which is often accompanied by vomiting. In later stages, the human skin acquires a grayish tint, back pain appears (if metastases also appeared in the pancreas), bleeding is possible. Only non-epithelial tumors of the stomach are asymptomatic in the first stages and are mostly benign.

The internal development of a stomach tumor occurs as follows:

• the cancer cell grows to about 2 cm;
• then it begins to penetrate both deep into the tissues and spread along the surface, preventing food from entering the stomach or entering the intestines, depending on its location;
• then it spreads to the colon and pancreas, and metastases penetrate the peritoneum, ovaries and liver.
• cancer cells separate and spread throughout the body through the bloodstream and lymph.

Diagnosis and treatment

To correctly establish the diagnosis and determine the stage of the disease, the patient must undergo appropriate tests:

1. x-ray of the pancreas;
2. Ultrasound of the abdomen;
3. gastroscopy;
4. biopsy;
5. cT scan.

This stage is the most important - the fate of the patient will depend on the results of this spectrum of studies. If a malignant tumor of the stomach was nevertheless found, then it is at this stage that its size, boundaries and stage of the disease itself are determined.

Most often, after the examination, a decision is made to remove part of the stomach or the entire stomach as a whole. If a stomach tumor, the treatment of which is no longer possible, has spread to other organs: the spleen, liver or intestines, then you need to remove them.

After the operation, in order to reduce the possibility of metastases and prolong remission, chemotherapy and radiation therapy are given, and a course of drugs with a high content of vitamins and minerals is prescribed to maintain and restore the body itself.

The meaning of chemotherapy is to destroy cancer cells. Sometimes it is prescribed before the operation and is an intravenous infusion of special drugs. Radiation therapy is carried out remotely and occurs due to irradiation of the necessary organs, which slows down the process of tumor development.

Treatment with folk remedies

It is difficult to imagine that such a serious disease can be cured only by auto-suggestion or folk remedies. Modern medicine does not allow the likelihood that such a treatment is possible and generally hardly recognizes alternative methods of treatment. Nevertheless, there are adherents of similar methods, and there are several reasons for this:

• More than once we have heard versions that a cure for any type of cancer has been invented long ago, but since treatment in most cases costs a sick person a lot, any attempts to leave chemotherapy and other treatment methods in the past are cut off. Pharmacology is a huge business that dictates to doctors how and with what it is worth treating patients. No one claims that known methods of treating cancer are ineffective, however, there are already a lot of questions to them.
• Sometimes doctors refuse to treat a patient, promising only to "reduce torment" - this also pushes people to self-medicate.
• There are many additional treatment methods to classical medicine - they do not go against the prescribed procedures and may very well help the patient in maintaining immunity. We will talk about these methods below.

Oil and juice treatment

This method of treatment is rather a panacea, a week officially recognized method of combating cancer, however, it has also been widely used. The thing is that the oils are saturated with useful substances and have enveloping properties that protects cells from damage. However, despite the general belief, the applicable oil directly inside the body at times reduces its beneficial properties - many substances are destroyed during digestion. The surest way to absorb all the beneficial substances is to rub it into previously cleansed skin.

For the treatment of cancerous tumors, the most saturated oils are used: avocado, sea buckthorn, cedar, chestnut, lilac, flax, eucalyptus, chicory oil, etc.

Juice treatment is a worthy alternative to oil treatment. The fact is that natural juices are saturated with vitamins and minerals, which are so needed by the body, invigorating with oncology. However, a weakened gastric compartment does not always cope with the digestion of food, and the consumption of juices markedly facilitates its work.

Juices that are most useful for gastric swelling are nettle and dandelion juice. They will bring especially much benefit in the spring season - at the beginning of ripening. The juice of these plants increases the body’s immune properties, saturates it with energy and increases its working capacity, so do not neglect at least a few spoons per day. It is better to consume juice before meals in order to increase acidity and facilitate the digestibility of food, however, this advice is relevant only in the case of low acidity of the stomach.

Do not forget about antioxidants, which are contained in large quantities in juices, and have an antitumor effect. If there are tumors, doctors advise replacing juices with an early breakfast, when the body is still saturated due to dinner.

Tumor development

Today, all the reasons why a gastrointestinal stromal tumor of the stomach appears are not yet fully understood, but we can already say that the basic patterns and risk zones have been identified, which allows us not only to fight its development, but also to carry out targeted prevention. Scientists have proven that the use of certain foods in food can significantly reduce the risk of a disease, while you should not look for a special diet, but just include a few products in the diet.

Timely studies, with the help of which it is possible to identify and remove a tumor in the early stages of its development, should not be neglected. It is worth paying attention to your body - do not postpone the examination for the following symptoms:

1. high fever that does not subside without the manifestation of other flu or cold symptoms;
2. rapid weight loss;
3. prostration;
4. change in taste habits;
5. impaired bowel function.

It cannot be denied that the main thing on the way to recovery is the patient’s very desire to recover - in this case, any treatment will take on a completely different meaning. At the moment, there is no true way to prevent the development of a tumor, and each of us is more or less at risk. However, you can very well minimize the possibility of illness - keep an eye on your diet, give up bad habits and do not start stomach diseases. After 45 years, it is worth taking the norm to come to the gastroenterologist for an appointment, so that, in the event of an inflammatory process, immediately identify it.