Remnant gastric leiomyosarcoma
Introduction
Introduction of residual gastric leiomyosarcoma Residual gastric leiomyosarcoma is a pathological type of residual gastric cancer, which refers to cancer that occurs in the residual stomach after several years of major gastrectomy due to benign or malignant diseases of the stomach. Most scholars believe that 5 years after the operation of benign gastric diseases, the cancer that occurs in the residual stomach 10 years after the malignant disease is called residual gastric cancer. basic knowledge Probability ratio: 1.3% of patients after gastrectomy Susceptible people: no specific people Mode of infection: non-infectious Complications: abdominal pain
Cause
Causes of residual gastric leiomyosarcoma
(1) Causes of the disease
The occurrence of residual gastric cancer, including gastric leiomyosarcoma, may be related to the following factors.
1. Gastrointestinal alkaline reflux gastrointestinal alkaline reflux can be seen in various gastrectomy, especially in the type II, the bile and pancreatic juice flow back into the stomach, long-term stimulation of the residual gastric mucosa, causing inflammation of the gastric mucosa, ulcers, With the passage of time, atrophy, intestinal metaplasia and atypical hyperplasia may occur, and it is proportional to the degree of reflux. Pancreatic juice may promote the carcinogen precursor in the stomach to become a carcinogen and induce cancer. It has also been shown that taurocholic acid alone can significantly promote nitrosoguanidine-induced residual gastric cancer.
2. Gastric emptying delays postoperative gastric contraction weakness, loss of milling function and motor dysfunction of the small intestine, often delaying gastric emptying, bacterial reproduction in the residual stomach, increasing the chance of contact with the residual gastric mucosa, aggravating Damage to the residual gastric mucosa.
3. In the stomach, the acidity of the stomach is reduced after the partial resection of the stomach, and the bile and pancreatic juice reflux, the pH of the gastric juice is increased, the bacteria is easy to grow, and the carcinogen activity is enhanced.
4. Chronic non-physiological stimulating factors at the anastomosis can cause gastric mucosal carcinogenesis, which is well known. Local anastomotic stimulation includes: mismatched anastomosis of different tissue layers, bringing mucosal tissue into the submucosa; locally formed scars Tissue bridge; gastric mucosa directly adjacent to the small intestinal mucosa and polypoid lesions around the anastomosis, these factors are conducive to the occurrence of residual gastric cancer.
(two) pathogenesis
Unlike residual gastric epithelial cancer, residual gastric leiomyosarcoma grows first in the wall. When the tumor volume increases to a certain extent, it can gradually squeeze the gastric mucosa into the cavity, and squeeze the serosa outside the cavity, which is expressed in X. On the line, it is a dumbbell-shaped mass. Sometimes the tumor is completely protruding from the stomach cavity. It is pedicled polypoid. Due to mucosal ischemia, nearly half of the patients can find the central ulcer of the tumor, which is clinically characterized as gastrointestinal bleeding.
Prevention
Residual gastric leiomyosarcoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Residual gastric leiomyosarcoma complications Complications, abdominal pain
The gastrointestinal leiomyosarcoma can reach the upper abdomen mass in the late stage, and the main parts of the metastasis are the lung and the liver.
Symptom
Residual stomach leiomyosarcoma symptoms Common symptoms Pain in the upper abdomen, block stool, habit, change, black stool, abdominal discomfort, weight loss
Remnant gastric leiomyosarcoma can be asymptomatic, even by endoscopy, X-ray and other follow-up found, if clinical manifestations, most see hematemesis and melena, other upper abdominal discomfort, stuffy or pain, bowel habits change, weight loss, etc. In the late stage, the upper abdomen mass can be touched, and the main part of the metastasis of leiomyosarcoma is lung and liver, and metastasis to the supraclavicular lymph nodes is rare.
Examine
Examination of residual gastric leiomyosarcoma
1.X line
Visible filling defects, shadows, such as ulcers, deep and multiple, or sinus leading to the tumor cavity, other visible mucosal disorders, destruction, varying degrees of expectorant through obstacles or abnormal walking.
2. Gastroscopic examination
Local ulcers or nodular hyperplasia can be found.
Diagnosis
Diagnosis and differentiation of residual gastric leiomyosarcoma
Diagnostic criteria
The typical manifestation of cutaneous leiomyosarcoma is tumor center ulcer, X-ray shows filling defect, sputum shadow, such as ulcer, large and deep, or sinus leading to the tumor cavity, it is strongly suggestive of this disease, other visible mucosal disorders , destruction, there are different degrees of barium through obstacles or abnormal walking, but the correct rate of diagnosis of residual gastric tumors by gastrointestinal barium meal imaging is only 30% to 60%, because the surgery caused the disappearance of normal anatomical landmarks and secondary mucosa Changes, it is easy to cover up the lesions, gastroscopy can be found in local ulcers or nodular hyperplasia, combined with biopsy, may be diagnosed before surgery.
Differential diagnosis
Residual gastric leiomyosarcoma should first be differentiated from residual gastritis. Residual gastritis usually develops from several months to several years after gastric surgery. Most of them have obvious symptoms. As in the middle and abdomen, persistent burning pain, antacids can not be relieved, and pain after meals is intensified. Can also appear biliary vomiting, bleeding and anemia, weight loss and other symptoms, gastroscopy see anastomotic patency, bile reflux, gastric mucosal congestion, edema or erosion and bleeding, lesions near the anastomotic mouth most serious, followed by the residual The identification of various epithelial cancers of the stomach usually requires a pathological examination to confirm the diagnosis.
