Rare gastric tumors: clinical presentations, endoscopic aspects and management challenges

ABSTRACT

Many challenges will be present on dealing with rare gastric tumors there. The aim of the present work was to study the clinical presentations, endoscopic aspects of some of the uncommon gastric tumors and the different lines of management of such cases. Ten patients, five males and five females, presented with rare gastric tumors were included in the study. Their age ranged between 42 and 73 years. The main presentations were; epigastric pain, vomiting associated with a sizable epigastric and right hypochondrial mass in one patient, upper gastro intestinal tract bleeding in four patients, vague epigastric pain and dyspeptic manifestation not responding to medication in two patients, non specific symptoms [abdominal pain and dyspepsia] which were modified by a known primary malignant disease and the effects of its treatment were the presentation in three patients. Esophago-gastro-duodenoscopy was done for all patients; [the number, site and appearance of the lesions were described], this was repeated twice for the first patient [one year interval] with evidence of GERD grade I and extrinsic antral compression with no definite masses or ulcers, no biopsy was taken. Endoscopic biopsy could not be taken in two patients, inconclusive in two [CT guided core liver biopsy settled the diagnosis in one patient with multiple liver secondaries while surgical resection specimen was the only option in the other three patients] and conclusive in five. Metastatic Gastric Tumors [MGT] were found in three patients, mesenchymal tumors in three, hepatoid adenocarcionoma, gastric carcinoid, and high grade MALT lymphoma one patient each and synchronous tumors in one patient [lower oesophageal adenocarcinoma and antral mesenchymal tumor]. The primary tumor was cutaneous malignant melanoma, breast adenocarcinoma, and pancreatic adenocarcinoma in the three patients with metastatic gastric tumors. Six patients were treated surgically; two by chemotherapy, one by percutaneous biliary drainage followed by chemo-radiotherapy, and one patient received supportive medication. Four patients are still alive during a follow up period of 12 - 32 months, while six patients died within 9 to 28 weeks from the time of diagnosis. The diagnosis of MGTs is often difficult as gastric involvement is usually masked by manifestations of the original tumor. A negative endoscopic biopsy in mesenchymal tumors with intact overlying gastric mucosa is always a diagnostic challenge. Poor response of most gastric tumors to chemo-radiotherapy makes surgery the main line of treatment