Primary Digestive Lymphoma: Anatomical, Clinical and Epidemiological Study

Abstract

Gastrointestinal lymphoma is a non-Hodgkin’s lymphoma that develops from MALT (Mucosa Associated Lymphoid Tissue). It is a rare entity representing 1% of tumors of the gastrointestinal tract. In Madagascar, few studies have been performed on these lymphomas. Our objective is to report a series of digestive lymphoma in order to evaluate the epidemiological and anatomical-clinical aspects. This was a retrospective, cross-sectional, descriptive bicentric study conducted at the Department of Pathology at the Soavinandriana Hospital Center (CENHOSOA) and the Department of Pathology at the University Hospital Center of Andrainjato over a period of 4 years from January 1st, 2016 to December 31st, 2019. During the study period, we collected 14 cases of primary digestive lymphoma representing 16% of all lymphomas. We noted a female predominance with a sex ratio of 0.75. The mean age of the patients was 35.64 years with extremes of 3 and 78 years. The clinical signs were dominated by occlusive syndrome (57.14%), abdominal pain (21.44%), digestive hemorrhage (7.14%), intestinal invagination (7.14%) and lingual swelling (7.14%). Regarding the location, the ileum was the most frequently affected (42.85%), followed by the stomach (14.29%), the ileo-caecal area (14.29%), the sigmoid (14.29%), the colon (7.14%) and we also noted a lingual location (7.14%). The most frequent histological type was diffuse large B cell lymphoma (42.86%) followed by MALT lymphoma (35.71%), Burkitt’s lymphoma (14.29%) and diffuse small cell lymphoma (unclassified) (7.14%). We did not observe a significant association (p > 0.05) between the site involvement and the histological subtypes. Among the 14 cases, 3 were confirmed by immunohistochemistry. Primary lymphomas of the gastrointestinal tract include several anatomic entities with different presentation and prognosis. Pathological examination is essential for diagnosis. Immunohistochemical examination is a valuable aid for immunophenotyping despite its difficult access in Madagascar. A multidisciplinary collaboration is necessary for an optimal management of these rare lymphomas.