Primary gastric T-cell lymphoma with and without human T-lymphotropic virus type 1.

Abstract

We would like to comment on a recent article by Shimada-Hiratsuka et al.,1 which described five cases of gastric T-cell lymphoma with and without human T-lymphotropic virus type 1. They referenced 33 previously reported cases of gastric T-cell lymphoma including those reported in the Japanese literature, and stated "the clinicopathologic features of T-cell lymphoma of the stomach have not yet been clarified." However, we call to your attention the fact that we previously have described the detailed clinicopathologic features of 14 patients with primary gastric T-cell lymphoma in Cancer in 1995.2 In our study,2 of the 233 cases of primary gastric lymphoma, 14 (6%) were found to be T-cell lymphomas (2 pleomorphic small, 10 pleomorphic medium-sized and large, and 2 large cell anaplastic); 2 patients were Stage IE, 3 were Stage II1E, 7 were Stage II2E, and the stage could not be determined in 2 patients. The MIB-1 (Ki-67) labeling indices of T-cell lymphoma (mean, 50.3%) were significantly higher than those of B-cell tumors (mean, 31.5%), and the survival probability for T-cell lymphoma was significantly lower than that for B-cell lymphoma. Multivariate analysis revealed the T-cell phenotype to be an independent predictor of poor prognosis in patients with primary gastric lymphoma.2 In addition, recently we found Helicobacter pylori in 11 of 15 patients with gastric T-cell lymphoma (73%),3 and also reported 1 additional patient with synchronous gastric T-cell lymphoma and adenocarcinoma who was coinfected with both H. pylori and the Epstein-Barr virus.4 We were surprised that Shimada-Hiratsuka et al. did not cite our work2 because their findings are partly consistent with our observations published 2 years before theirs, although they did perform a more detailed immunohistochemical and molecular analysis than we did. Shotaro Nakamura M.D.*, Masazumi Tsuneyoshi M.D.