20160223 Gasztro Fak GI Traktus SapiZ

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20160223 Gasztro Fak GI Traktus SapiZ

Transcript of 20160223 Gasztro Fak GI Traktus SapiZ

  • Papilloma

    (>90%)

    -

    -

    de CK +)

    -

    Adenocarcinoma (

  • Adenocarcinoma (

  • Oesophagealis carcinoma

    Etiologia:

    Gomba contaminatio

    Reflux oesophagitis

    Barret esophagus

    Histologia:

    Squamous cell carcinoma

    Adenocarcinoma

    Mechanicus strictura (cachexia)

    Tracheo-esophagealis fistula

    Mediastinitis

    6/100.000 USA-ban 1-

  • Gyomor tumorok

    Gyomor polypusok

    A/ Epithelialis

    neoplasticus: adenoma

    - tubulare

    - villosum

    nem neoplasticus: hyperplasticus (leggyakoribb)

    hamartomatosus

    - Peutz-Jeghers

    - juvenilis

    - fundus mirigy polypus

    - foveolaris polypus

    inflammatoricus

    B/ Nem epithelialis (GIST, stb.)

  • Polypus hyperplasticus ventriculi

    -

    -

    -

    -

    -

    -

    - nem praecancerosis

  • Fundus mirigy polypus

    -

    -

    -

    -

    - nem praecancerosis (sporadikus esetben)

  • Adenoma ventriculi

    - ritka

    - >2cm, polypoid vagy

    - tubularis, villosus

    -

    basophilia)

    -

    60-85%-

    -

  • WHO 1980

    GEP- NET

    WHO 2000

    GEP- NET

    WHO 2010

    GEP- NET

    1. Carcinoid 1.(WDNET)

    - Adenoma G1

    - / borderline G2

    1.

    2.

    G3 (WDNEC)

    3. Rosszul diff. NE cc. /kissejtes cc. (PDNEC) -G3

    3. Rosszul diff.NEC G3 kis/nagysejtes

    2. Mucocarcinoid Kevert carcinoid -adenocarcinoma

    4. Kevert exocrin -endocrin cc. (MEEC)

    4. Kevert adenoneuro -endocrin cc. (MANEC)

    3. Pseudotumor

    (TLL)

  • Type 1: 80% - G1/2

    Autoimmun gastritis

    Antrumban G- -sejtek: Hyperplasia,

    microcarcinoidosis

    ECL, EC, Somatostatinsejtek

    Type 2: 3%: MEN-1/ZES assz. Typ2-NET: corpus-fundus - G1/2

    MEN-1 gastrinoma a duodenumban (Zollinger-Ellison syndr.)

    Multiplex,

  • Type 1 gyomor NET

    Gastric carcinoids after long-term use of a proton pump inhibitor (Jianu et al, AP&T, 2012)

    PPIs - hypergastrinaemia: NE

    Fundic gland polyp)

  • ECL (enterochromaffin-like) sejtes carcinoid fundusban

    chromogranin

  • APPENDIX

    NET a leggyakoribb appendix daganat

    Klinikum: acut appendicitis

    1-2 cm distalis

    nycsm

    Insularis szerkezet

    Serotonin (EC sejtek), Substanz P

    Carcinoid syndroma

    chromogranin

  • COLON, RECTUM

    50-

    Colon: ritka, 3-4 cm polyposus

    Rectum: 1-2 cm gyakoribb

    >2 cm: 82% metastasis

    Serotonin Carcinoid syndroma ritka

    Glukagon

  • OctreoScan ( Indium-111-DTPA, D-Phe-Octreotid)

    Somatostatin-Receptor-Scintigraphia (SRS) 70-90%, >1 cm

    PET-CT (Ga-labeled somatostatin analog) 93% senz, spec

    - DOTATOC

    Inoperabilis, metastaticus tumorok

    appendix Langerhans sziget