gastric lipoma
Introduction
Introduction to gastric lipoma Liparomphalus ofstomach is a benign interstitial tumor of the stomach with low incidence, slow progression, minimal malignant transformation, and good prognosis. Gastric lipoma is more common in middle-aged people, and there is no significant difference in the incidence of men and women. basic knowledge The proportion of illness: 0.002% Susceptible people: more common in middle-aged people Mode of infection: non-infectious Complications: abdominal pain, gastrointestinal bleeding, anemia
Cause
Causes of gastric lipoma
(1) Causes of the disease
Adipose tissue occurs at the 14th week of the embryo. At the 24th week, the fat lobular structure has been basically formed. The development of fat cells is divided into four stages: primitive stromal cells, pre-adipocytes, adipocytes and mature adipocytes, lipoma. Adipocytes can be present in each of the above different stages of development, but mainly composed of mature adipocytes.
(two) pathogenesis
Gastric lipoma can occur in the corpus and antrum of the stomach, and is more common in the antrum of the stomach. 90% is derived from submucosal growth, and the tumor protrudes into the stomach cavity to form an intragastric type; 10% grows under the serosa and into the abdominal cavity. Prominent formation of the stomach.
1. General observation: 80% to 90% of gastric lipoma is a single tumor, 10% to 20% can be multiple, the tumor is often a sessile spheroid mass, can also be lobulated, a few cases can have pedicle, multiple There may be a bundle of gastric lipoma tumors. The size of the tumor varies from 2 to 5 cm. The larger one has a tumor diameter of 15 cm. The surface of the gastric lipoma is smooth, with a complete capsule, soft touch, and even Sliding in the stomach wall, the mucosa covering the tumor often causes erosion and even ulceration due to mechanical friction, gastric juice damage or tumor over-malignant dystrophy. The tumor section is pale yellow, translucent, soft and delicate, if the fat cells are liquefied. The liquid chamber is formed.
2. Microscopic observation: The tumor consists of differentiated mature fat cells, arranged closely, and the fibrous trabeculae divides them into small leaves of different sizes. The tumor cells are round, the cytoplasm is lightly stained, and the nucleus is located in the peripheral part, tumor tissue. There may be unequal amounts of fibrous tissue or rich in blood vessels, or with mucoid degeneration. If these lesions are present, they may be called fibrosis, angiolipoma and mucinous lipoma, respectively. Pathologically, there is a type of gastric lipoma. Special, under the microscope, there is a lot of fat cell infiltration between the submucosal discrete muscle fibers. In most areas, there is adipose tissue between the mucosa and the serosa. During this period, the blood vessels are easy to see, but there is no lobular structure formation tendency, and no tumor cell abnormality and The mitotic image, which is called gastric invasive lipoma, should be distinguished from gastric liposarcoma.
Prevention
Gastric lipoma 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
Gastric lipoma complications Complications abdominal pain gastrointestinal bleeding anemia
Gastric lipoma generally has no obvious symptoms. It only occurs when there is a complication. When the surface mucosa of the tumor can be erosive or even ulcerated, the patient has abdominal pain and gastrointestinal bleeding, often black stool, less hematemesis, long-term chronic blood loss. The patient may have anemia.
Symptom
Symptoms of gastric lipoma, common symptoms, upper abdominal discomfort, stomach pain, gastrointestinal bleeding
Gastric lipoma generally has no obvious symptoms. Symptoms only occur when there are comorbidities. In the vicinity of Tuen Mun, there may be difficulty in swallowing. Patients in the pyloric area may have pyloric obstruction symptoms. If there is ulcer on the surface of the tumor, stomach discomfort may occur. , pain and similar symptoms of gastric ulcer or chronic gastritis, about 50% of cases may have bleeding, gastric lipoma occasionally malignant, the larger tumor in the physical examination can touch the soft texture on the upper abdomen, activity, borders are still clear Lump.
Examine
Gastric lipoma examination
Patients often have gastrointestinal bleeding, which is positive for fecal occult blood test, and histopathological examination is the basis for diagnosis.
1. X-ray barium meal examination: upper gastrointestinal barium meal can find tumors larger than 2cm in diameter, visible edge clear, round or oval filling defects, barium meal can suggest that the mass is located under the mucosa, but can not distinguish between lipoma and other submucosal Lesions, changes in shape when oppressing tumors are characteristic of lipomas, but only large tumors can be manifested. In addition to the common features of gastric submucosal tumors, gastric lipomas have lower density of adipose tissue and softer texture. Unique performance:
(1) The defect area caused by the mass is more translucent and the contrast is more distinct.
(2) Deformation: The lipoma is soft, and the size and shape of the defect may change when pressurized. When filling the phase, it may even be hidden. When the muscle wall of the stomach wall contracts, the tumor can be squeezed. When the contraction phase is small, it tends to be elliptical. The relaxation phase becomes larger and rounded.
(3) Displacement: The filling defect of the lipoma in the anterior pyloric area is more likely to move to the bottom of the duodenal bulb with the pyloric tube and the "decolation sign" appears, and the pyloric tube is also widened at the same time.
2. CT examination: Abdominal CT can not only understand the growth of the tumor in the wall, but also can measure the CT value, understand the tumor tissue structure, achieve the purpose of clear diagnosis, have certain diagnostic value, can distinguish fat and other tissues, There are several cases reported by CT.
3. Endoscopic diagnosis: Endoscopy is a more accurate diagnosis method, the positive rate is higher, but need to pay attention to the identification of extracorporeal tumor compression, a smooth surface, yellow or orange, soft mass, tumor The surface mucosa is less elastic and is not easily retracted after being pulled by the biopsy forceps to form a tent sign. When the tumor is pressed, a pressure trace is formed, such as a sponge. The conventional biopsy can not reach the submucosal tumor, and the deep biopsy can be used to obtain the biopsy. Tumor tissue, sometimes ulcers can be seen on the surface of the tumor. When the bulge partially covers the normal mucosa and ulcers form, it needs to be differentiated from cancer. More than 2cm is mostly ectopic pancreas, carcinoid or myogenic tumor, fat. Tumors are rare. When it is difficult to determine the biopsy of tumors larger than 2 cm, Saito Rikohiko uses ulcers mixed with yttrium aluminum garnet (Nd-YAG) laser or ethanol, and then takes biopsy in the deep part of the ulcer. Even so, there are still Missed diagnosis or misdiagnosis, so the routine use of endoscopic ultrasound is necessary.
4. Endoscopic Ultrasound: A diffuse hyperechoic mass under the mucosa can be found, which is helpful for diagnosis.
Diagnosis
Diagnosis and differentiation of gastric lipoma
Need to be differentiated from gastric cancer, ectopic pancreas, carcinoid or myogenic tumors.
1. Chronic gastritis: The most common manifestations are upper abdominal pain and fullness, pain without obvious rhythm, can be aggravated during meals or fasting, in addition, there may be hernia, acid reflux, nausea, early satiety, upper abdominal discomfort or burning Symptoms and other symptoms, some patients have loss of appetite, fatigue and weight loss, combined with gastric mucosal erosion can occur upper gastrointestinal bleeding, mainly black feces, a few can vomit blood, chronic atrophic gastritis symptoms are more serious, can also appear Giant cell anemia, the signs of chronic gastritis are not obvious, some patients may have mild tenderness in the upper abdomen.
2. Peptic ulcer: duodenal ulcer pain is located in the upper abdomen, most of them are right under the xiphoid process, even in the left rib, stomach ulcers under the stomach and the cardia appear as pain in the left front chest or left upper abdomen, after Wall ulcer pain can be radiated to the back, and the nature of the pain can be burnt, sputum, hunger or chewing pain, or only manifest as discomfort.
3. Gastric cancer: manifested as upper abdominal discomfort, fullness, lack of regular pain, pain when light and heavy, to the middle, late, the pain is more severe, and can be persistent, due to loss of appetite, eating less, patients gradually lose weight , weight loss, often accompanied by edema.
