Non-Carcinomatous Tumors of the Stomach

Abstract

THE relatively infrequent non-carcinomatous gastric tumors vary widely in gross morphology and associated roentgen manifestations. Benign tumors are frequently recognized (4); the others are seldom diagnosed roentgenographically. When a carcinoma or a benign tumor is simulated, the confusion is not so serious, if all gastric tumors are considered at least potentially malignant, and, when possible, subjected to microscopic proof. However, under a diagnosis of polyposis, hypertrophic gastritis, benign ulcer, or syphilis, surgery or irradiation may be withheld. Also sarcoma, still resectable, may resemble frankly inoperable gastric carcinoma or abdominal tumor (9). It may then be justifiable, in spite of the generally ackowledged absence of reliable roentgen signs, to survey these variegated lesions together for any predilections, roentgenographic or clinical, which will justify suspicion of their presence. Benign tumors of the stomach have been considered rare, but recent literature has established that they are not as uncommon as previously supposed. Careful roentgenologic and pathologic studies have lifted these lesions from comparative obscurity. The incidence of benign tumors has been found to be 1.3 per cent by Eusterman and Senty (14), less than 2 per cent by Kirklin and Weber (quoted by Rigler and Ericksen, 32), about 4.5 per cent by Lockwood (24), and recently Rigler and Ericksen (32) put the figure at approximately 11 per cent. Reiniets (31) made a careful examination in 200 consecutive postmortems and found small single or multiple gastric leiomyomas in 17 per cent, demonstrating that a meticulous search raised the pathologic incidence considerably. Benign tumors had a predilection for the pylorus in 69 per cent of the cases, 25 per cent being situated in the body and 5 percent in the cardia. The Balfour series (2) of 58 cases of benign tumor of the stomach is probably a fair representation of predilective sites. Of 14 single adenomatous polyps, one was on the anterior wall, four on the posterior wall in the body, and nine on the posterior wall in the prepyloric region. In four cases of adenoma, three were near the pylorus and one on the anterior wall near the mid-stomach. Under the general group of fibromas, myomas, fibromyomas, adenomyomas, and myxofibromas, 10 tumors were situated near the pylorus, two in the antrum, two in the midgastric region, and one in the cardia. In our case of gastric tuberculoma the lesion was on the greater curvature in the prepyloric region (Fig. 1). Overfilling of the stomach with the barium was the commonest cause of the failure to make a diagnosis. The rugal pattern was obliterated and often a tumor of relatively moderate size was hidden. Adequate manipulation and palpation, pressure on the stomach, and films made during roentgenoscopy gave better visualization and localization. Small defects of the anterior and posterior walls of the stomach were brought out by films of heavy penetration (32).