Study of Patients with Malignant Lymphoma Diagnosed By Upper Endoscopy

Abstract

Background and Aim: The gastrointestinal tract is one of the most commonly involved extranodal sites of malignant lymphoma (ML). These lesions may be seen as primary GI lymphoma or as secondary one. Our interest in lymphomatous neoplasia of the GI tract is due to the large number of patients with ML diagnosed by upper endoscopy. A retrospective study of patients with ML was conducted in an attempt to examine clinical and endoscopic features of ML. Patients and Methods: 56 patients with ML (75 lesions) diagnosed by upper endoscopy between April 1, 2000 and August 31, 2008 were enrolled. We analyzed clinical features, localization, macroscopic morphology, and differences in the histological diagnosis. And, we also examined the feature of magnified endoscopic images with the narrow band imaging (NBI) system in recent 4 patients. Results: 56 patients (age: 62.91 ± 14.23, sex: M/F 34/22) with ML were confirmed. 27 lesions (36%) of ML occurred in middle third stomach, 20 lesions (26.7%) in lower third stomach, 13 lesions (17.3%) in duodenum, 8 lesions (10.7%) in upper third stomach, 5 lesions (6.7%) in entire stomach, and 2 lesions (2.7%) in esophagus. In terms of macroscopic morphology, 32 lesions (42.7%) were present as superficial depressed type, 19 lesions (25.3%) as ulcer type, 13 lesions (17.3%) as fungated type, 6 lesions (8%) as polypoid type, 5 lesions (6.7%) as giant fold type. Out of them, 13 lesions (17.3%) were present as a single ulcer. In the histological diagnosis, there were 38 patients (67.9%) with diffuse large B-cell lymphoma (DLBCL) (50 lesions, including 5 entire stomach lesions), 8 patients (14.3%) with MALT lymphoma (11 lesions), 4 patients (7.1%) with follicular lymphoma (6 lesions), 4 patients (7.1%) with mantle cell lymphoma (6 lesions), 1 patient (1.8%) with Burkitt's lymphoma, and 1 patient (1.8%) with adult T-cell lymphoma. Helicobacter pylori was present histologically in 6 patients (75%) of MALT lymphoma group. In a magnified endoscopic imaging with NBI, we could recognize disappearance of regular gastric pits or appearance of irregular vessel pattern in all of 4 patients with ML (2 with DLBCL, 1 with Mantle cell lymphoma, and 1 with MALT lymphoma). Limitation: This was a single-center study. Conclusion: Clinical and endoscopic features of malignant lymphoma were varied. Therefore, we should treat these lesions carefully.