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PYLORIC MASS

BENIGN

Peptic ulcer citatrisation

Tricobazor

Superior Mesenteric vessel syndrome

Annular pancrease

Celiac lymphadenopathy

MALIGNANT

Gastric Carcinoma

Head of pancreas cancer

Infiltration of pylorus by Gall bladder and liver carcinoma

EPONYMS

Troisier ' s sign - Virchows node palpable

Sister joseph nodule

Krukenberg tumor

Blomers cell tumor

Stump carcinoma

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1. Significance of growth in pyloric region - could cause gastric outlet obstruction... Causes include - cicatrisation of duodenal ulcer, carcinoma of stomach.

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1. Significance of growth in pyloric region - could cause gastric outlet obstruction... Causes include - cicatrisation of duodenal ulcer, carcinoma of stomach.

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2. Troisiers sign, Sister Mary Joseph nodules, Irish nodes

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1. What is the significance of mass in pyloric region?

The significance of a mass in the pyloric region, especially in the context of the clinical scenario described (58-year-old male with fatigue, epigastric discomfort, weight loss, early satiety, dark colored stools, history of chronic gastritis, and heavy smoking, along with a palpable epigastric mass and left supraclavicular lymphadenopathy), is highly suggestive of gastric carcinoma (stomach cancer).

The pyloric region is a common site for gastric tumors. A mass in this area can indicate the primary tumor itself. The symptoms like weight loss, early satiety, and dark stools (melena, indicating upper GI bleeding) are classic signs of advanced gastric cancer.

2. What is the eponym of supraclavicular lymphadenopathy? List some other eponyms used in clinical practice regarding carcinoma stomach.

* Eponym of supraclavicular lymphadenopathy: The eponym for left supraclavicular lymphadenopathy, particularly in the context of gastric or other abdominal malignancies, is Virchow's node (also known as Troisier's sign). It indicates metastatic spread to the lymphatic system.

* Other eponyms used in clinical practice regarding carcinoma stomach:

* Krukenberg tumor: Refers to metastatic adenocarcinoma in the ovary, typically originating from the gastrointestinal tract, most commonly the stomach.

* Sister Mary Joseph nodule: A metastatic tumor in the umbilicus, often originating from gastric, ovarian, or pancreatic cancer.

* Blumer's shelf: A palpable shelf-like lesion in the rectum, indicating metastatic deposits from abdominal malignancies, including gastric cancer, that have spread to the rectovesical or rectouterine pouch.

* Irish node: An enlarged anterior axillary lymph node, which can be a metastatic site from gastric carcinoma (less common than Vircho

w's node).

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---Pyloric Mass ----

•Malignant Causes:

1. Gastric Adenocarcinoma(most common malignancy).

2. Gastrointestinal Stromal Tumor (GIST)

3. Pancreatic Cancer (invading pylorus).

4. Metastatic Tumors (e.g., melanoma, breast).

5. Lymphoma(e.g., MALT lymphoma).

6. Pancreatic carcinoma

7. Gall bladder and biliary tract carcinoma

•Benign Causes:

1. Congenital hypertrophic Pyloric Stenosis ( in infants ).

2. Peptic Ulcer Disease (chronic, with scarring/fibrosis leading to cicatisation ).

3. Hyperplastic Polyps or Adenomas

4. Pancreatic (Heterotopic Pancreas, annular pancreas)

5. TrichoBezoar(ingested hair mass).

6. Inflammatory Pseudotumor

---Eponyms---

1. Troisier's Sign

- Metastasis to left supraclavicular lymph node- Virchow's node

2. Krukenberg Tumor

- Ovarian metastasis of gastric cancer.

3. Sister Mary Joseph Nodule

- Periumbilical nodule from peritoneal metastasis.

4. Blumer's Shelf

- Rectal shelf palpable on exam due to peritoneal metastasis.

5. Irish's Syndrome (Trifecta of Gastric Cancer)

- Acanthosis nigricans, hyperkeratosis, and tripe palms.

6. Bormann Classification

- Macroscopic growth patterns of gastric cancer (Types I–IV).

7. Linitis Plastica ("Leather Bottle Stomach")

8. Billroth I/II

- Surgical reconstructions post-gastrectomy (not a tumor type, but associated management).

9. Stump carcinoma- carcinoma due to bile reflex after 10-20 years after gastrojejnostomy

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Mass in pyloric region can be benign or malignant. BENIGN mass may be leiomyoma which is rare.CIACATRISATION of pyloric ulcer can mimic like a mass which leads to pyloric stenosis.It may be malignant like GASTRIC CARCINOMA,GASRIC LYMPHOMA.Any mass whether it is benign or malignant ,if it totally occludes the pylorus,food cannot pass.so symptoms like projectile vomiting of undigested food,loss of weight,loss of appetite,continuous vomiting leads to dehydration,abdominal pain,mass per abdomen,anemia.

2. Eponym of left supraclavicular lymphadenopathy-Troisier sign

3. Irish node-left axillary lymphadenopathy

4. Sister Mary Joseph nodule -nodule around umbilicus

5. Blumer shelf-rectal deposits of carcinoma

6. Krukenberg tumor-transperitoneal spread of carcinoma to ovary through paraaortic lymph node

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1) Significance of mass in pyloric region

Gastric carcinoma(adenocarcinoma)

can cause gastric outlet obstruction (in late stage) - early satiety, epigastric fullness, weight loss, vomiting

palpable epigastric mass

2) Eponym of left supraclavicular lymphadenopathy - Virchow’s node

Irish node - left axillary lymphadenopathy

Blumer’s shelf - hard mass can be felt on rectal examination

Sister Mary Joseph nodule - periumblical nodule ( metastatic spread from gastric or ovarian cancer)

Krukenberg tumor - ovarian metastasis of gastric carcinoma

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Pyloric obstruction delayed gastric emptying

Early satiety, projectile vomiting, weight loss

Infiltrative tumors in the pylorus can spread to nearby structures

May present with epigastric fullness and succussion splash

Virchow’s node

Left supraclavicular lymph node

Sign of gastric carcinoma metastasis via thoracic duct drainage

Other eponyms used in gastric carcinoma clinical practice:

Eponym Description

Sister Mary Joseph nodule Periumbilical metastatic nodule usually from GI or ovarian cancer

Blumer’s shelf Palpable mass on rectal exam peritoneal metastasis

Irish node Left axillary lymph node metastasis

Krukenberg tumor Bilateral ovarian metastases from gastric adenocarcinoma

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1. What is the significance of a mass in the pyloric region?

Pyloric obstruction → delayed gastric emptying

Early satiety, projectile vomiting, weight loss

Infiltrative tumors in the pylorus can spread to nearby structures

May present with epigastric fullness and succussion splash

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2. What is the eponym of supraclavicular lymphadenopathy?

Virchow’s node

Left supraclavicular lymph node

Sign of gastric carcinoma metastasis via thoracic duct drainage

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Other eponyms used in gastric carcinoma clinical practice:

Eponym Description

Sister Mary Joseph nodule Periumbilical metastatic nodule (usually from GI or ovarian cancer)

Blumer’s shelf Palpable mass on rectal exam → peritoneal metastasis

Irish node Left axillary lymph node metastasis

Krukenberg tumor Bilateral ovarian metastases from gastric adenocarcinoma

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1. The mass can cause gastric outlet obstruction which causes the symptoms of the patient.

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1. The mass can cause gastric outlet obstruction which causes the symptoms of the patient.

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Causes: cicatrisation of duodenal ulcer

Distal CA stomach

2. Virchow node; other eponyms - Irish node, Sister Mary Joseph nodules