Benign lymphoid hyperplasia of the stomach and duodenum.

Abstract

Gastric lymphoid hyperplasia or pseudolymphoma of the stomach has been described as a benign pathologic entity which may clinically simulate various malignant tumors and has been misinterpreted histologically as lymphosarcoma (3, 4, 8). The alleged inclusion of some cases of pseudolymphoma in reported series of gastrointestinal malignant lymphoma has been implicated in high cure rates (3, 8). The etiology of pseudolymphoma is controversial, but many believe it to be a manifestation of a chronic inflammatory process (2–4, 7, 8). Others have postulated a hamartomatous origin (5). This report describes the clinical, radiographic, and pathologic features in 15 cases of pseudolymphoma of the stomach recorded in the files of the Division of Surgical Pathology, Washington University School of Medicine, St. Louis, Mo., from 1948 to 1963 (11 from Barnes Hospital, St. Louis, and 4 in consultation), in which preoperative gastrointestinal roentgenographic studies were performed. The material forms part of a clinicopathological study reported elsewhere (3). Clinical Findings All the patients were forty years of age or more at the time of diagnosis, with an average age of 57.2 years. Ten were men and 5 women; 13 were Caucasian and 2 Negro. The majority of the patients gave a history of long-standing gastrointestinal complaints. The most frequently observed symptoms were nausea (13 cases)—accompanied by intermittent vomiting in 7 patients, epigastric pain (10 cases), weight loss (7 cases), and hematemesis and/or melena (5 cases). A palpable mass in the epigastrium was present in only 2 patients. No clinically significant lymphadenopathy or splenomegaly was noted in any case. The liver was moderately enlarged in 2 instances. Almost half the patients had some degree of anemia with hemoglobin values as low as 6 and 7.5 g per 100 cc in 2 cases. Radiographic Findings In our review of the gastrointestinal studies several roentgenographic patterns have become evident (table i). A. Tumor mass with mucosal ulceration: A large filling defect in the gastric lumen, usually the body or the antrum, was seen in 5 cases. Ordinarily, the mucosa was not severely distorted but showed some superficial ulceration and at times spiculation or a large ulcer niche (Fig. 1, A and B). Severe destruction and alteration of the mucosal relief was observed in 2 of these patients. B. Infiltrating and/or constricting lesion: Predominantly constricting lesions of the body or antrum of the stomach, usually involving large segments of the organ, were noted in 4 cases. In addition, all these showed evidence of mucosal ulceration with large craters seen in 2 patients (Fig. 2, A and B). The only case of pseudolymphoma of the duodenum in this series presented as a regular concentric narrowing of the proximal duodenum associated with a small ulcer crater in the postbulbar region (Fig. 3, A and B).