Gastric Carcinoma

1) Pathology- Gastric carcinoma + Surgery done, Signet ring cells.

a) what are the two major risk factors for gastric cancer?

b) Explain the pathology report to the family in 4 sentences

c) 7- or 10-days post operative have. Axillary vein thrombosis, what is in this patient
predispose to this? (hypercoagulation in malignancy, Age, major surgery)

d) 6 months later came with ascites & liver functions deranged?

 Metastasis to liver

e) What the two pathological tests to do?

 Ascites tap, to see what? Cells (cytology)
 Liver biopsy to see what?? Cells and liver architecture + accepted but I think there
was something else here. (confirm underlying malignancy/pathology)

f) What is the ttt for this patient now? Two things???? I do not know??? Tried chemotherapy
& radiotherapy? But was wrong.

2) Pathology- GIST
Histopathology report showing GIST, sarcoma, ulceration, CD 117, nodal involvement,
no spread otherwise. H. Pylori

a) Difference between GIST and gastric adenocarcinoma

 GIST: typically (70%) benign tumors, which are most commonly caused when genes
controlling tyrosine kinase expression undergo mutation leading to neoplastic growth
involving cells from the lineage of the interstitial cells of Cajal; lymphatic spread is
extremely rare; Mutually exclusive mutations of the KIT (CD 117)
 Gastric Adenocarcinoma: malignant proliferation of surface epithelial cells of
stomach (meaning malignancy is arises from cells of stomach itself)

b) How is the tumor likely to behave (It had gone through lymph nodes but no distant
metastasis)
https://www.ncbi.nlm.nih.gov/books/NBK554541/
 GIST: Most commonly, patients with these tumors present with gastrointestinal
bleeding, which may present as an acute bleed with melena or hematochezia, or as
chronic bleeding with associated anemia and sequelae thereof.
 In addition to gastrointestinal bleeding, GISTs may also present with signs and
symptoms of a mass effect caused by the tumor such as abdominal pain or discomfort,
early satiety, abdominal distension, or palpable mass. In an additional 15% to 30% of
cases, GISTs are found incidentally on surgery, imaging, or autopsy.

c) Why is the patient jaundiced?

 Possible metastasis to liver
d) What is jaundice? yellow discoloration of the body tissue resulting from the
accumulation of excess bilirubin

e) Patient develops ascites how do you investigate (cytology and liver biopsy for recurrence)

f) What is CD 117 (happy with immunohistology marker)

g) What is H. pylori: gram-negative spiral-shaped bacterium; forms urease to combat acidic

environment of stomach and then thrives

h) What does it cause: chronic or atrophic gastritis, peptic ulcer, gastric lymphoma, and
gastric carcinoma

3) Signet ring Carcinoma of stomach, Gastrectomy with splenectomy, pathology report.

a) What are the two major risk factors for gastric cancer?
 Tobacco smoke
 Nitrosamines Male
 Blood group A
 H. Pylori.

b) Explain the pathology report to the family in 4 sentences, Look at Patho report, and pick
out main points to tell family:
 Signet cell, nodes positive, margins not clear.
 Prognosis poor
 Require chemo
 May require another surgery.

c) What are 2 pathological investigations you can use to confirm this? (Totally no idea. I gave
him CTAP, US HBS, AFP all of which was not what he wanted).
 Do an peritoneal tap with cytology.

d) 7- or 10-days post operative have Axillary vein thrombosis, what is in this patient
predispose to this???(hypercoagulation in malignancy, Age, major surgery)

e) 6 months later came with ascites & liver functions deranged?

f) What the two pathological tests to do? Ascites tap, to see what?? Cells & liver biopsy to see
what?? Cells and liver architecture + accepted but I think there was something else Here.

g) What is the treatment for this patient now??? Two things???? I do not know??? Tried
chemotherapy & radiotherapy? But was wrong.