Diagnosis Of Gastric Lymphoma Research Articles

Non-Hodgkin’s Gastric Lymphoma: Case Report

More than 95% of gastric lymphomas are Non-Hodgkin’s lymphoma. It is very difficult to distinguish primary gastric lymphoma from secondary stomach dissemination. Here we reported a case of high-grade B cell type Non-Hodgkin’s gastric lymphoma. The patient presented with upper abdominal swelling associated with anorexia, vomiting, and weight loss. He was hemodynamically unstable and needed ICU support. But before starting R-CHOP chemotherapy he was expired. The diagnosis of gastric lymphoma can be delayed for many years due to the presence of nonspecific symptoms. High-grade Non-Hodgkin’s lymphoma is very aggressive, but treatment response is better than low-grade lymphoma. Here we suggest early diagnosis and management of high-grade Non-Hodgkin’s gastric lymphoma to save the patient’s life.

The Role of Radiation Therapy and Risk of Developing Secondary Gastric Cancer in Patients Presenting with Early Stage Gastric Lymphoma

▪Background: Gastric lymphoma is one of the most common extranodal lymphomas. Stage I/II disease is commonly treated with chemotherapy with or without radiation (RT). Although the development of secondary gastric cancers after treatment is a concern, the risk is not well described, and the role of histologic subtype and treatment remain unclear.Patients and Methods: TheSurveillance, Epidemiology and End Results (SEER) database was used to estimate cumulative incidence (CI) of secondary gastric cancer among adult (≥18 yrs) patients diagnosed with stage I/II gastric lymphoma between 1983 and 2014. We excluded patients who had history of gastric cancer prior to the diagnosis of lymphoma. Cumulative incidence (CI) of gastric cancer was calculated using competing risk regression analysis and death without having gastric cancer was defined as competing event.Results: A total of 10,192 patients were diagnosed with stage I/II gastic lymphoma of whom we excluded 321 patients with prior gastric neoplasm and 258 patients diagnosed with gastric cancer concurrently with lymphoma. The median age of the patients was 69 years (range, 18-104). Marginal zone lymphoma (MZL, N=3,981) was the most common histology followed by diffuse large B-cell lymphoma (DLBCL, N=3,944). After a median follow up of 76 months (range: 0-381 months), 417 patients developed secondary gastric cancer, and 173 (41%) died of gastric cancer. The 5-year and 10-year CI of gastric cancer was 4.1% (95%CI: 3.7-4.6%) and 4.8% (95%CI: 4.3-5.2%), respectively, 87% of secondary gastric cancer was diagnosed within 5 years after diagnosis of gastric lymphoma (Figure A).Patients with MZL had a higher risk of secondary gastric cancer compared to patients with DLBCL (SHR: 1.55, 95%CI: 1.26-1.92, Figure B). RT was associated with higher risk of second gastric cancer in earlier priod (1983-2000, SHR 2.06, 95%CI: 1.20-3.51) but not in recent period (2001-2014, SHR: 1.04, 95%CI: 0.81-1.34). RT for the treatment of gastric lymphoma was associated with significant longer overall survival for both patients with MZL (HR: 0.83, 95%CI: 0.74-0.92) and DLBCL (HR: 0.60, 95%CI: 0.53-0.69).Summary: Patients with gastric lymphoma have a low risk of developing secondary gastric cancers, though patients with MZL have a higher risk than those with DLBCL. RT is associated with significantly longer survival without increasing risk of secondary gastric cancer. [Display omitted] DisclosuresWestin:Kite Pharma: Membership on an entity's Board of Directors or advisory committees; Novartis Pharmaceuticals Corporation: Membership on an entity's Board of Directors or advisory committees; Apotex: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Neelapu:Merck: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Poseida Therapeutics, Inc: Research Funding; Cellectis Inc.: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Karus: Research Funding. Fanale:MERCK: Membership on an entity's Board of Directors or advisory committees, Research Funding; CELGENE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GENENTECH: Research Funding; AMGEN: Membership on an entity's Board of Directors or advisory committees; ONYX: Research Funding; MOLECULAR TEMPLATES: Research Funding; ADC THERAPEUTICS: Research Funding; SEATTLE GENETICS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; TAKEDA: Honoraria, Research Funding; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Nastoupil:TG Therapeutics: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding; Gilead: Honoraria; Karus Therapeutics: Research Funding; Genentech: Honoraria, Research Funding; Celgene: Honoraria, Research Funding.

The Effects of Radiation Therapy (RT) and Surgical Resection on Overall Survival in Gastric Lymphoma

Introduction:Lymphoma of the stomach is an uncommon tumor. However, it is the most common extra-nodal manifestation of Non-Hodgkin lymphoma. Over the last few decades, preferred treatment for gastric lymphoma has shifted from surgical resection to non-surgical methods involving chemotherapy and RT. The current standard treatment is chemo-immunotherapy. The role of RT and surgery, if any, is unclear.Methods:We reviewed data which was obtained from the Surveillance, Epidemiology and End Results (SEER) data registry for patients with gastric lymphoma from 1973 until 2011. The data was analyzed using Microsoft Excel and statistical analysis was performed using SPSS statistical software. The SEER registry does not provide information about chemotherapy (CT) administered.Results:We analyzed 13,659 patients with the diagnosis of gastric lymphoma in the SEER database. The three most prevalent subtypes were diffuse large B-cell lymphoma (DLBCL) with 6,134 (44.9%) cases, extranodal marginal zone lymphoma (MZL) with 4,318 (31.6%) cases and chronic lymphocytic leukemia (CLL/SLL) with 352 (2.5%) cases.In the DLBCL group, the median (range) age was 71 (4 – 105) years, of which 44.7% were female and 55.3% male. Of the group, 4,992 (81%) patients were White, 447 (7%) Black, and the remainder were Asian, Pacific Islander, or Native American. The median overall survival (OS) in patients who did and did not receive RT was 63 vs. 34 months (p<0.01). Analysis by stage shows median OS with and without RT was 108 vs. 65 months in Stage I disease (p<0.01), 71 vs. 62 months (p=0.41) in Stage II disease, 59 vs. 25 months in Stage III disease (p=0.52), and 8 vs. 8 months in Stage IV disease (p=0.46).The median OS in patients who underwent surgical resection, at least partial gastrectomy, is 76 months compared to 28 months in patients who did not undergo resection (p<0.01) (Fig.1). Analyzed by stage, the median OS in patients who did and who did not undergo surgery was 114 vs. 59 months in Stage I disease (p<0.01), 70 vs. 54 months in Stage II disease (p=0.03), 50 vs. 22 months in Stage III disease (p=0.63), and 10 vs. 8 months in Stage IV disease (p=0.85).Since widespread use of rituximab started in 2001, we analyzed patients treated before and after that year. Among patients with DLBCL, 2,719 (44%) were diagnosed prior to 2001 and 3,415 (56%) were diagnosed in 2001 or afterwards. Median OS with and without RT was 43 months vs. 31 months prior to 2001 and 97 months vs. 39 months after 2001 (p<0.01). The median OS with and without surgery is 81 vs. 12 months prior to 2001 (Fig. 2) and 57 vs. 51 months after 2001 (Fig. 3) (p<0.01).In the MZL group, the median (range) age was 68 (10 – 101) years of which 50.5% were female and 49.5% male. Of the group, 3,457 (80%) patients were White, 392 (9%) Black, and the remainder were Asian, Pacific Islander, or Native American. The median OS of patients with MZL who had surgery and who did not was 146 vs. 145 months (p=0.372). Analysis by stage shows no significance difference in OS either. The median OS of patients who did not undergo RT was 132 months and was not yet reached in patients who underwent RT (p<0.01). Analysis by stage shows RT significantly benefitted patients with Stage I and II disease but not stage III and IV disease.Conclusion:Our analysis shows that patients with DLBCL who undergo RT have improved median OS. The benefit is limited to Stage I disease. Improved median OS is seen in patients with DLBCL who undergo surgical resection which is contrary to recent data. The benefit of surgical resection is seen only in Stage I and II but not in Stage III and IV. The benefit of surgery was present prior to 2001 but not seen after 2001 - after the widespread use of rituximab. In MZL, surgical resection has no impact on median OS; whereas RT improves OS, particularly in Stage I and II disease. While our analysis is limited due to the lack of data regarding chemotherapy administered, this large population based analysis supports the benefit of RT and surgery in select disease stages. Prospective clinical trials may better address the benefits of each modality independently. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Helicobacter pyloriinfection in gastric mucosa-associated lymphoid tissue lymphoma

Gastrointestinal lymphoma is the most common type of extranodal lymphoma, and most commonly affects the stomach. Marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphoma are the most common histologic types of gastric lymphoma. Despite its increasing incidence, diagnosis of gastric lymphoma is difficult at an earlier stage due to its nonspecific symptoms and endoscopic findings, and, thus, a high index of suspicion, and multiple, deep, repeated biopsies at abnormally and normally appearing sites in the stomach are needed. In addition, testing for Helicobacter pylori (H. pylori) infection and endoscopic ultrasonography to determine the depth of tumor invasion and involvement of regional lymph nodes is essential for predicting response to H. pylori eradication and for assessment of disease progression. In addition, H. pylori infection and MALT lymphoma development are associated, and complete regression of low-grade MALT lymphomas after H. pylori eradication has been demonstrated. Radiotherapy and/or chemotherapy can be used in cases that show poor response to H. pylori eradication, negativity for H. pylori infection, or high-grade lymphoma.

Premalignant gastric lesions in patients with gastric mucosa-associated lymphoid tissue lymphoma and metachronous gastric adenocarcinoma

Patients with gastric mucosa-associated lymphoid tissue lymphoma or diffuse large B-cell lymphoma have an increased risk of developing gastric carcinoma (GC). Identifying patients at high GC risk may lead to improved survival and prognosis. The aim of this case-control study was to evaluate whether premalignant gastric lesions are more prevalent and severe in gastric lymphoma (GL) patients with a subsequent diagnosis of GC than in those without GC. Patients with a first GL diagnosis from 1991-2008 were identified in the Dutch histopathology registry (PALGA). Cases were patients with a diagnosis of GL and a subsequent diagnosis of GC. Controls were patients with a diagnosis of GL without GC development. In total, eight cases (mean follow-up 5.5 years) and 31 controls (mean follow-up 5.3 years) were included (mean age 60 years). At lymphoma diagnosis, six (75%) cases were diagnosed with premalignant lesions, whereas in the control group, 21 (68%) had histological evidence for premalignant lesions (P=0.69). At GC diagnosis, five (63%) cases showed intestinal metaplasia in the surrounding gastric mucosa. In 22 (71%) controls premalignant lesions were present at the end of follow-up (P=0.47). No differences were demonstrated in the prevalence of premalignant lesions of cases and controls at GL diagnosis or the end of follow-up. As the prevalence of premalignant lesions is substantial in both the groups of patients, careful endoscopic surveillance of GL patients is warranted not only for recurrence of lymphoma, but also for progression to adenocarcinoma.

The Role Of Diffusion-Weighted Mr Imaging And Adc Values In The Diagnosis Of Gastric Tumors

The aim of this study was to investigate the role of diffusion-weighted MR imaging (DWI) in the diagnosis of gastric tumors by means of measuring the apparent diffusion coefficient (ADC) values of these lesions, and making a comparison with the endoscopic biopsy results. Seventy patients having gastric tumor constituted the case group. For the control group 30 healthy individuals were included. Abdominal MRI examinations were performed with a 1,5 Tesla unit. DWI examinations were obtained by single shot spin echoplanar imaging. The ADC was measured based on the tissue of the gastric tumoral entities and normal gastric mucosa in the control group. Mean ADC values were 0,84 +/- 0,17 x 10(-3) mm2/s and 1,79 +/- 0,08 x 10 mm2/s in gastric tumor group and in control group, respectively, being statistically significant (p<0.05).There was no significance among ADC values of adenocarcinoma subgroups. The comparison of the ADC values in the adenocarcinoma and lymphoma cases were also found to be statistically significant. DWI is beneficial in the diagnosis of malignant gastric lesions by the aid of ADC measurements. Although ADC quantification seems to be invaluable in the evaluation of histopathologic subgroups of adenocarcinoma, it can help in the diagnosis of gastric lymphoma.

Repeating Gastric Biopsy for Accuracy of Gastric Lymphoma Diagnosis

Gastric lymphoma is characterized by a good prognosis with slow progression and a nonspecific appearance under the endoscope. A biopsy is performed for accurate diagnosis. For this study, endoscopy and biopsy specimens were analyzed retrospectively to investigate the rate of accurate diagnosis of gastric lymphoma in first-, second-, and third-round endoscopic and biopsy procedures and to understand the causes of discrepancies. Fifty-four cases of gastric lymphoma were diagnosed in 32,000 patients. The rate of positive Helicobacter pylori infection was 70.4%. Of these, 13 cases were diffuse large B-cell lymphoma and 41 cases were marginal zone B-cell lymphoma. Thirty-two gastric lymphoma cases (59.3%) were diagnosed by first-round endoscopy and biopsy, 13 (24.1%) cases required second-round endoscopy and biopsy, and 9 (16.7%) cases were determined in the third round of endoscopic and biopsy procedures. Repeating endoscopy and biopsy reduced discrepancies in the diagnosis of gastric lymphoma by 40.8%, which can significantly improve the overall accuracy of diagnosis and treatment of gastric lymphoma.

Management of stage one and two-E gastric large B-cell lymphoma: chemotherapy alone or surgery followed by chemotherapy?

Management of localized primary gastric B lymphoma (PGL) remains controversial. The aim of this study is to compare two treatments: chemotherapy alone and surgery plus chemotherapy.MaterialsRecords of all patients with a diagnosis of gastric lymphoma and which were treated in the National Institute of Oncology, between 1999 and 2006, were reviewed and patients fulfilling the following criteria were included in this study: histologically proven large-cell B lymphoma of the stomach; complete clinical information stage I/II disease according to the Musshoff staging; patients who received surgery followed by chemotherapy (group I) or chemotherapy alone (group II).ResultsThis study included 82 patients who were treated for cancer in our Institute. All clinical and pathological features were similar between the two groups, except that patients of group-I had significantly more stage II disease (P = 0.023) than that of group II. Among the 52 patients who could be evaluated for response to chemotherapy, there were 45 who had complete response to treatment, 3 had partial response to the treatment and 4 had progressive disease. The projected 5-year relapse-free survival (RFS) and overall survival (OS) of group I were 86.69% (95% CI, 57.9 - 97.7%) and 90.0% (95% CI, 58.0 - 97.8%), respectively. And the projected 5-year relapse-free survival RFS and OS of group II were 86.67% (95% CI, 57.0 - 88.2%) and 93.33% (95% CI, 73.3 - 98.7%) respectively. There were no statistically significant differences in RFS (P = 0.485) and OS (P = 0.551) between the two groups.ConclusionOur data suggest that chemotherapy alone may be a reasonable alternative treatment for stage I/II gastric large-cell lymphoma but this result must be confirmed by prospective randomized clinical trials.

Helicobacter pylori and gastric lymphoma: high seroprevalence of CagA in diffuse large B-cell lymphoma but not in low-grade lymphoma of mucosa-associated lymphoid tissue type.

Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) type is closely related to Helicobacter pylori (H. pylori) infection. In vitro studies have demonstrated H. pylori-induced B cell proliferation to be strain dependent. High prevalences of CagA protein and FldA protein have been reported in strains obtained from patients with gastric lymphoma of MALT type. The aims of the present study were to evaluate the prevalence of H. pylori infection and to search for antigenic particularities in 53 patients with primary gastric lymphoma in comparison with a group of infected patients with benign disease. Of the 53 patients, 37 presented with low-grade lymphoma of MALT type (LGLM) and 16 with diffuse large B-cell lymphoma (DLBCL). They were compared to a group of 162 H. pylori-infected subjects comprising the control group: 111 had gastric or duodenal ulcer (GDU) and 51 nonulcer dyspepsia (NUD). Diagnosis of gastric lymphoma was established on histological examination of endoscopic specimens. Anti-H. pylori antibodies were assayed by third-generation ELISA. Western blot assay was used to detect antibodies against nine antigens (including CagA protein), which were recognized on the basis of their molecular weight. Of the 53 patients with gastric lymphoma, 45 were H. pylori-positive (85%): of these, 25 (56.5%) had anti-CagA antibodies. The prevalence of H. pylori seropositivity was 78% (29/37) in LGLM and 100% (16/16) in DLBCL. The prevalence of CagA seropositivity in H. pylori-positive patients was 44.8% (13/29) and 75% (12/16), respectively (p < 0.05). In comparison, the seroprevalence of CagA was 77.4% (86/111) in GDU patients and 43.1% (22/53) in NUD patients. The prevalence of antibodies to other antigenic proteins detected with Helicoblot 2.0 (19.5kd, 30kd, 35kd, VacA, HSPb, Urease A, and Urease B) did not differ among the groups except for 35kd protein, which was significantly higher (p < 0.01) in GDU than in NUD and in LGLM (76.6% vs 49% and 46.7%). These findings suggest that in patients who develop gastric lymphomas in response to H. pylori, virulent strains expressing CagA protein are preferentially associated with DLBCL.

Helicobacter pylori and gastric lymphoma: high seroprevalence of CagA in diffuse large B-cell lymphoma but not in low-grade lymphoma of mucosa-associated lymphoid tissue type

OBJECTIVE: Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) type is closely related to Helicobacter pylori (H. pylori) infection. In vitro studies have demonstrated H. pylori-induced B cell proliferation to be strain dependent. High prevalences of CagA protein and FldA protein have been reported in strains obtained from patients with gastric lymphoma of MALT type. The aims of the present study were to evaluate the prevalence of H. pylori infection and to search for antigenic particularities in 53 patients with primary gastric lymphoma in comparison with a group of infected patients with benign disease. METHODS: Of the 53 patients, 37 presented with low-grade lymphoma of MALT type (LGLM) and 16 with diffuse large B-cell lymphoma (DLBCL). They were compared to a group of 162 H. pylori-infected subjects comprising the control group: 111 had gastric or duodenal ulcer (GDU) and 51 nonulcer dyspepsia (NUD). Diagnosis of gastric lymphoma was established on histological examination of endoscopic specimens. Anti- H. pylori antibodies were assayed by third-generation ELISA. Western blot assay was used to detect antibodies against nine antigens (including CagA protein), which were recognized on the basis of their molecular weight. RESULTS: Of the 53 patients with gastric lymphoma, 45 were H. pylori-positive (85%); of these, 25 (56.5%) had anti-CagA antibodies. The prevalence of H. pylori seropositivity was 78% (29/37) in LGLM and 100% (16/16) in DLBCL. The prevalence of CagA seropositivity in H. pylori-positive patients was 44.8% (13/29) and 75% (12/16), respectively ( p < 0.05). In comparison, the seroprevalence of CagA was 77.4% (86/111) in GDU patients and 43.1% (22/53) in NUD patients. The prevalence of antibodies to other antigenic proteins detected with Helicoblot 2.0 (19.5kd, 30kd, 35kd, VacA, HSPb, Urease A, and Urease B) did not differ among the groups except for 35kd protein, which was significantly higher ( p < 0.01) in GDU than in NUD and in LGLM (76.6% vs 49% and 46.7%). CONCLUSION: These findings suggest that in patients who develop gastric lymphomas in response to H. pylori, virulent strains expressing CagA protein are preferentially associated with DLBCL.

7228 Role of endoscopic ultrasonography in the diagnosis and staging of primary gastric lymphoma.

Background and Study Aims: Endoscopic Ultrasonography (EUS)is currently indicated for evaluating gastric neoplasm, given its ability to visualize the lining of the stomach and to scan the wall and neighbouring tissues (organs, vessels, lymph nodes). We aimed to value the role of this technique in the diagnosis and staging of primary gastric lymphoma. Patients and Methods:We performed a retrospective study on 37 consecutive patients who had undergone EUS because of clinical suspicion for primary gastric lymphoma. The endoscopic ultrasound system used was Olympus GF-UM 20. Echoendoscopic findings were compared to histologic diagnosis from biopsies. For statistical analysis, the chi-square test was used. Results: Histologic evaluation of the endoscopic bioptic specimens diagnosed gastric lymphoma in 30/37 subjects; conventional biochemical and instrumental procedures excluded secondary disease of the stomach. EUS detected gastric lymphoma in a total of 27 patients, with no false positive results, therefore diagnostic rates were: sensitivity of 90%; specificity of 100%; positive predictability of 100%; negative predictability of 70%; diagnostic accuracy of 92%. All the 27 patients in whom EUS had disclosed lymphoma underwent endosonographic staging: in 25 patients who required medical treatment, EUS staging was compared with histological grading from biopsies, to which it showed a good correlation; in 2 patients who were to be operated on, it could be directly compared with pathologic post-operative examination of the resected speciments,resulting correct in both cases as regard tumor depth of infiltration (T1b), but overstaging 1 case as regards lymph node involvement (N1 on EUS, instead of N0). Conclusions:The diagnosis of gastric lymphoma is based on multiple endoscopic biopsies, with EUS providing a complementary evaluation, particularly helpful in difficult cases; in locoregional staging, on the other hand, endosonography plays a primary role, especially in exploring tumor depth of invasion. Background and Study Aims: Endoscopic Ultrasonography (EUS)is currently indicated for evaluating gastric neoplasm, given its ability to visualize the lining of the stomach and to scan the wall and neighbouring tissues (organs, vessels, lymph nodes). We aimed to value the role of this technique in the diagnosis and staging of primary gastric lymphoma. Patients and Methods:We performed a retrospective study on 37 consecutive patients who had undergone EUS because of clinical suspicion for primary gastric lymphoma. The endoscopic ultrasound system used was Olympus GF-UM 20. Echoendoscopic findings were compared to histologic diagnosis from biopsies. For statistical analysis, the chi-square test was used. Results: Histologic evaluation of the endoscopic bioptic specimens diagnosed gastric lymphoma in 30/37 subjects; conventional biochemical and instrumental procedures excluded secondary disease of the stomach. EUS detected gastric lymphoma in a total of 27 patients, with no false positive results, therefore diagnostic rates were: sensitivity of 90%; specificity of 100%; positive predictability of 100%; negative predictability of 70%; diagnostic accuracy of 92%. All the 27 patients in whom EUS had disclosed lymphoma underwent endosonographic staging: in 25 patients who required medical treatment, EUS staging was compared with histological grading from biopsies, to which it showed a good correlation; in 2 patients who were to be operated on, it could be directly compared with pathologic post-operative examination of the resected speciments,resulting correct in both cases as regard tumor depth of infiltration (T1b), but overstaging 1 case as regards lymph node involvement (N1 on EUS, instead of N0). Conclusions:The diagnosis of gastric lymphoma is based on multiple endoscopic biopsies, with EUS providing a complementary evaluation, particularly helpful in difficult cases; in locoregional staging, on the other hand, endosonography plays a primary role, especially in exploring tumor depth of invasion.

Chemotherapy alone versus surgery followed by chemotherapy for stage I/IIE large-cell lymphoma of the stomach.

The optimal treatment of localized large-cell lymphoma of the stomach remains controversial. In particular, the role of surgical resection of the primary tumor needs to be clearly defined. We have reviewed all patients with a diagnosis of gastric lymphoma and treated in our institutions between 1988 and 1998. Patients fulfilling the following criteria were included in this study: (1) histologically proven large-cell lymphoma of the stomach; (2) adequate pathological materials and complete clinical information for analysis; (3) clinical stage I/II disease according to the Musshoff modification of Ann Arbor system; and (4) received primary chemotherapy alone with anthracycline- or anthracenedione-containing regimens (group A) or curative surgery followed by adjuvant chemotherapy (group B). There were 38 and 21 patients in group A and group B, respectively. All pertinent clinicopathologic features were similar between the two groups of patients, except that patients of group A had significantly more stage II-2 disease (P = 0.004). Of group A, among 36 patients who could be evaluated for response to chemotherapy, there were 29 complete and 1 partial responses, with an overall response rate of 83.3% (95% CI, 71.1-95.5%). The projected 5-year relapse-free survival (RFS) and overall survival (OS) were 86.0% (95% CI, 73.3-98.7%) and 72.6% (95% CI, 57.0-88.2%), respectively. On the other hand, the projected 5-year RFS and OS of group B were 77.9% (95% CI, 58.0-97.8%) and 77.8% (95% CI, 57.9-97. 7%), respectively, not significantly different from that of group A. Our data suggest that systemic chemotherapy alone may be a reasonable alternative treatment for stage I/II large-cell lymphoma of the stomach. Resection of the primary tumor before systemic chemotherapy does not appear to improve the cure rate of this group of patients.

PEP 5005 Diagnosis of gastric lymphoma in 16-year old boy established by endoscopic ultrasonography (EUS) - case report

PEP 5005 Diagnosis of gastric lymphoma in 16-year old boy established by endoscopic ultrasonography (EUS) - case report

Long-Term Follow-Up After Curative Surgery for Early Gastric Lymphoma

This study was designed to examine the long-term survival of a homogenous group of patients with stage IE or IIE-1 gastric lymphoma after complete surgical resection. The management of gastric lymphoma remains controversial. Enthusiasm for multimodality approaches for gastric lymphoma has lead to the current trend of using chemotherapy as primary treatment, thus avoiding gastric resection. Surgery, however, may result in improved long-term survival rates. The records of all patients with the diagnosis of gastric lymphoma from 1980 to 1991 were reviewed retrospectively. Of 106 patients examined, 34 underwent curative resection and regional lymphadenectomy for pathologically staged IE or IIE-1 (pN1) gastric lymphoma. Fifteen patients underwent surgery alone, whereas 19 also received postoperative adjuvant therapy. The median follow-up time was 74 months. The 10-year actuarial disease-free survival was 91% for stage IE disease (n = 23) and 82% for stage IIE-1 disease (n = 11). There were no operative deaths and a 26% morbidity rate. No difference in survival was found for those treated with adjuvant therapy. The results compare favorably to those reported with the use of primary chemotherapy and radiation therapy and suggest that surgery remains the best frontline therapy for early gastric lymphoma.

Pointers to the diagnosis of gastric lymphoma on computed tomography

The computed tomographic features of 12 patients with primary gastric non-Hodgkin's lymphoma and a further seven patients with gastric involvement by disseminated non-Hodgkin's lymphoma have been reviewed. In eight of these 19 patients there were clefts within the area of gastric wall involved by lymphoma where oral contrast medium passed to within 2 mm of the serosal surface in and amongst areas of gastric wall thickening (maximal thickness ranging from 18 to 40 mm). In three of these patients some clefts extended beyond the expected margin of the stomach to enter into, and be contained by, a composite soft tissue mass of stomach, spleen and splenic hilar nodes. Awareness of these features, which are in keeping with the known range of macroscopic pathological appearances in non-Hodgkin's lymphoma, may help the radiologist to recognize this potentially curable disease.

Does gastric adenocarcinoma develop after the treatment of gastric lymphoma?

Two adult patients with the diagnosis of gastric lymphoma who developed adenocarcinoma of the stomach 8 years after the treatment are presented. Both patients were treated by subtotal gastrectomy followed by irradiation of 4,000-4,500 cGy to the epigastric region and six courses of chemotherapy (vincristine, cyclophosphamide, prednisolone). In our review of the literature, 16 cases of gastric adenocarcinoma following the treatment of gastric lymphoma were found and listed with details. The factors influencing the development of this secondary carcinoma, mainly those treatment related are discussed. The possible role of both radiotherapy and chemotherapy in shortening the latent period for the development of stump carcinoma is emphasized.

The role of the endoscopic biopsy in the diagnosis of gastric lymphoma: A morphologic and immunohistochemical reappraisal

Forty-three endoscopic biopsies from 29 patients with confirmed gastric lymphoma (GL) were analyzed retrospectively to establish the morphologic criteria of greatest diagnostic significance. An average of 10 tissue samples was obtained at each endoscopy. In 44% of the cases, lymphoma was discovered in only one or two of the tissue portions. Eighteen lymphomas were primary, six were probably primary, and five were generalized. The diagnosis of lymphoma was originally suspected or established in 46% of the biopsies. However, a review of the histologic sections indicated that the changes, either diagnostic of or compatible with lymphoma, were present in 75% and 18% of the sections, respectively. Most diagnostic errors consisted of confusion with diffuse lymphoid infiltrates in chronic gastritis and/or peptic ulcer, and less frequently with poorly differentiated carcinoma. In those cases confused with chronic gastritis or peptic ulcer, biopsies showed centrocyte-like cells of the standard type or small lymphocytes which produced: (1) a marked increase in density of the lymphoid infiltrate in the gastric mucosa, (2) massive substitution of gastric glands by lymphoid infiltration, and (3) a collection of lymphocytes infiltrating and partially destroying isolated glands (lymphoepithelial lesion). From 48 biopsies having intense benign lymphoid infiltrates, three were interpreted (by means of a blinded study) as compatible with GL. In poorly differentiated neoplasms (blastic and pleomorphic types), cytologic features were sufficient to diagnose GL or malignant neoplasms; immunohistochemical techniques were useful to define their lymphoid nature. It is concluded that many GLs can be suspected or correctly diagnosed by routine endoscopic biopsy.

Immunophenotyping in the management of gastric lymphoma

Primary gastric lymphoma is a rare tumor in which surgical resection plays a major role in improving the response rate and reducing the incidence of bleeding and perforation after chemotherapy. In 17 consecutive patients, the diagnosis of gastric lymphoma was made by immunophenotyping snap-frozen endoscopic biopsy specimens. All neoplasms were B-cell lymphomas. Pan B surface marker antigens were present in all patients. Levels of Ki-67, a nuclear marker of tumor proliferation, were greater than 45% in two of the four patients who died after progression of their lymphoma. All patients alive had Ki-67 levels of less than 30%. A lower proliferation index, as measured by Ki-67, appears to be associated with better prognosis. Ten of 11 patients treated by resection prior to chemotherapy had no complications. Immunophenotyping is the key in the differential diagnosis when considering malignant lymphoma with gastric carcinoma and benign conditions such as pseudolymphoma.

Endoscopy with guided biopsy and cytology in diagnosis of gastric lymphomas

In the 3 000 gastric endoscopic examinations which were performed in the last 3 years at our center, 253 neoplasias were detected of which 20 were bioptically identified as lymphomas (7.7 %). The patients group with lymphomas were made up of 17 patients referred because of gastrointestinal symptoms while 3 underwent examination to determine the spread of a previously diagnosed lymphoma. The location, form and type of gastric lesions and the results of biopsy and guided cytology samples according to Rappaport classification were described. An evaluation of the degree of malignancy following the criteria of Kiel was made. The diffuse histiocytic form was the most frequent finding, and 11 lymphomas were classified as large cells at high grade malignancy. No correlation was found between endoscopic aspects of the lesion, histologic types and degree of malignancy.

Disseminated lymphoma involving the stomach

Esophagogastroscopy was performed on 15 patients with disseminated lymphoma and suspected gastric involvement. Positive diagnoses for lymphoma were obtained in 2 of 15 biopsies (13%); 1 of 15 brush touch preparations (7%); and 2 of 15 standard cytology washings (13%). The gastroscopic observations were enlarged nondistensible folds in 13 of 15 patients (87%); multiple superficial ulcerations in 11 of 15 (73%); enlarged nodular ulcerations in 8 of 15 (53%); and large polypoid masses in 4 of 15 patients (27%). Our results suggest that the gastroscopic appearance was of considerably greater help in the diagnosis of gastric lymphoma than were directed brush cytology, biopsy, and cytology washings. This may be due to the infiltrative submucosal nature of secondary lymphoma and the superficial capacity of endoscopic biopsies. This experience with gastric lymphoma reemphasizes the importance of gastroscopic observations but should not deter continuation of an aggressive approach utilizing directed cytology and biopsy.