Primary Gastrointestinal non-Hodgkin's Lymphoma Research Articles

Clinical characteristics and prognostic factors for primary pediatric and adolescent Non-Hodgkin Lymphomas of the gastrointestinal tract: a population-based study

PurposeTo investigate the clinical features and survival outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) in pediatric and adolescent population, we conducted a population-based cohort study.MethodsAll pediatric and adolescent patients with PGINHL diagnosed between 2000 and 2019 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Kaplane-Meier estimations were used to generate survival curves based on various criteria. To compare survival curves, the log-rank test was applied. A multivariate Cox proportional hazards model was developed to investigate the effect of each component on overall survival.ResultsA total of 334 pediatric and adolescent with PGINHL patients were identified. The median age at diagnosis was 12 years (range 1.0–19 years). Tumors were most commonly found in the small bowel (47.3%), followed by the large bowel (42.8%) and the stomach (9.9%). Overall, the most common histological subtype was Burkitt lymphoma (56.9%), followed by diffuse large B-cell lymphoma (DLBCL) (27.8%). Overall survival rates for all patients were 92.2% at 5- year and 91.6% at 10- year, respectively. The Cox proportional hazard regression revealed that only chemotherapy was an important independent predictor in this model. Patients with chemotherapy have a higher survival rate than those without.ConclusionsOur study revealed that only chemotherapy was found to be the most important predictor of the OS in pediatric and adolescent PGINHL, providing critical information for therapeutic care.

Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study.

Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11-99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25-59.6%) and ulcer type (15.6-50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.

Persistent Stomach Pain In The young Age Patient: A Case Of Primary Gastric Burkitt's Lymphoma

Lymphoma is the second most common gastric cancer, following gastric adenocarcinoma. Most gastric lymphomas are mucosa-associated lymphoid tissue lymphomas or diffuse large B-cell lymphomas. Primary gastric Burkitt’s lymphoma is a subtype of non-Hodgkin lymphoma and represents an aggressive and rare malignity with the fewest cases reported globally. Primary gastrointestinal non-Hodgkin lymphoma is a rare condition. Burkitt’s lymphoma is an aggressive form of B-cell lymphoma endemic to Africa while it is not endemic to the rest of the world. Here we presented a young immunocompetent male patient who had weight loss and was admitted with a stomachache. Upper gastrointestinal endoscopy and biopsy detected a large primary gastric Burkitt’s lymphoma. While long-term survival rates are possible with early diagnosis and timely appropriate treatment, delay in treatment can be fatal for such patients.

S3398 Duodenal Follicular Lymphoma: Two Distinct Presentations of a Rare Disease Entity

Introduction: Follicular Lymphoma (FL), a B cell neoplasm, is the second most common type of nodal NHL with frequent duodenal involvement mostly presenting with non-specific abdominal pain. Primary Gastrointestinal Non-Hodgkin Lymphoma (PGINHL) is a rare entity accounting for 2% of all small intestinal malignancies. Duodenal Follicular Lymphoma (DFL) only accounts for 1 to 6% of PGINHL. We present two cases of DFL with variable symptoms. Case Description/Methods: Case 1: A 58-year-old female presented with nausea, vomiting, acid reflux, and 60-pound weight loss over one year. She denied any fever, night sweats, family history of malignancy and had a normal upper and lower endoscopy 5 years ago. EGD showed nodular mucosa in the 2nd portion of the duodenum confirmed to be low-grade FL on biopsy. Metastatic workup showed stage 4 lymphoma. There was no evidence of bulky lymphadenopathy and diagnosis of DFL was made. Patient finished 6 cycles of R-CHOP therapy due to concern for recurrent/residual DFL and currently remains indolent. Case 2: A 41-year-old male presented with coffee-ground emesis, melena, and 10 lbs weight loss over a month in absence of NSAID use. He also had fever, palpitations, and diaphoresis. Patient’s grandfather had colon cancer and the mother had non-Hodgkin lymphoma and breast cancer. EGD and colonoscopy 9 months prior to presentation showed erosive gastritis and tubular adenoma, respectively. Repeat EGD showed abnormal duodenal mucosa with an area of oozing at the site of the biopsy. Pathology report supported the diagnosis of low-grade DFL. Metastatic workup showed a mediastinal mass, a large 7.7 × 4.9 × 7 cm mesenteric nodal mass, and a 5.8 cm × 5.9 cm duodenal mass involving the head of the pancreas. The patient moved to Iowa for further workup (Figure). Discussion: DFL is an extremely rare PGINHL with an indolent course and good prognosis. DFL has unique features in that immunohistochemically it is similar to nodal FL, however, gene expression analysis groups it closer to MALT lymphoma, and thus, treatment options are heterogeneous with no established guidelines. ‘Wait and Watch’ strategy is often implemented in patients with low-grade disease, however, chemotherapy, radiation therapy, and immunotherapy have also been explored. Treatment of DFL with antibiotics owing to its similarity to and association with MALT lymphoma and H. pylori respectively has had mixed results. The two cases described above highlight heterogeneous presentation, dyspepsia, and upper GI bleed, of a rare malignancy - DFL.Figure 1.: The image on the left shows whitish nodular mucosa in the second portion of the duodenum in Case 1. The image on the right shows abnormal duodenal mucosa in Case 2.

Clinical Characteristics of 219 Patients with Primary Gastrointestinal Non-Hodgkin's Lymphoma

To analyze the clinical and pathological characteristics of primary gastrointestinal non-Hodgkin's lymphoma (PGI-NHL) patients, and to explore the factors affecting the patients' survival and prognosis. The clinical data of 219 patients with PGI-NHL diagnosed in our hospital from March 2009 to April 2016 was collected and retrospectively analyzed. Survival analysis was performed by using the Kaplan-Meier method. Log-rank test was used for comparison among the groups, and Cox regression was used for multivariate analysis. Among the 219 patients with PGI-NHL, 126 patients were males and 93 patients were females. 182 patients were IPI 0 to 2 and 37 patients were IPI 3 to 5. There were 205 cases (93.6%) of B cell phenotype and 14 cases (6.4%) of T cell phenotype. 140 patients (63.9%) were patients with primary gastric NHL, including 85 DLBCL and 19 MALT. 79 cases (36.1%) were patients with primary intestinal NHL, including 46 DLBCL, 4 MALT, 7 FL, 3 MCL and 4 Burkitt lymphoma. 23 cases were HP positive and received anti-HP therapy. 57 cases and 32 cases received surgery and chemotherapy respectively. 84 cases received combination treatment of surgery and chemotherapy and 11 cases received combination treatment of radiotherapy and chemotherapy. Overall survival (OS) of indolent B-cell non-Hodgkin's lymphoma was longer than that of invasive B-cell non-Hodgkin's lymphoma, which shows better prognose. Kaplan-Meier analysis showed that there was no difference between progression-free survival (PFS) and OS in the patients with different origin sites, age and sex. There was no significant difference in PFS between B-cell and T-cell-derived patients, whereas OS of B-cell-derived PGI-NHL patients was longer than that of T-cell-derived PGI-NHL patients. The OS and PFS of patients with IPI 0-2 were longer than those of patients with IPI 3-5. According to Lugano and Ann Arbor staging systems, there was no difference in prognosis of patients between phase I/II and III/IV. The prognosis of patients treated with surgery alone was worse than that of patients treated with combination therapy, and the prognosis of patients with surgery combined with chemotherapy was not significantly different from that of patients with chemotherapy alone. B-cell phenotype, indolent and low IPI score lymphoma indicate better prognosis, while that of different origin site, sex and age shows no different in prognosis. Surgery is used only for emergency case or pathological materials, and these patients should be treated with chemotherapy-based combined treatment.

A Retrospective Analysis of Primary Gastrointestinal Non-Hodgkin Lymphomas: Clinical Features, Prognostic Factors and Treatment Outcomes.

IntroductionPrimary gastrointestinal non-Hodgkin lymphoma (PGIL) is a rare hematopoietic malignancy with limited data to guide management.MethodsWe analyzed the clinical characteristics and survival of 219 newly diagnosed PGIL patients.ResultsOur single-center data showed that the incidence rate of primary gastric lymphoma (PGL) was higher than that of primary intestine lymphoma (PIL). Most PGIL was B-cell originated and DLBCL was the most common pathological type both in PGL and PIL group. Univariate and multivariate analysis showed that IPI score and pathology were independent prognostic factors. The overall survival (OS) and progression-free survival (PFS) of patients with MYC rearrangement were much shorter compared to patients without MYC rearrangement indicating that MYC translocation was related to decreased survival. Neither OS nor PFS differed between patients who received chemotherapy with or without surgery. However, patients who received surgery alone had a poor prognosis.ConclusionChemotherapy is the front-line treatment for PGIL while surgery was conducted to relieve tumor-related complications or make diagnosis. MYC rearrangement predicted poor prognosis of PGIL patients.

Incidence rates and clinical characteristics of primary gastrointestinal non-Hodgkin lymphoma: a population study.

After the rise of lymphoma incidence in the 1990's, there is a paucity of epidemiologic studies describing the characteristics of primary gastrointestinal non-Hodgkin's lymphoma (PGIL). This epidemiologic survey aims to identify recent trends in PGIL. A retrospective, population-based study describing adult patients with PGIL in the Israeli Negev region between 1998 and 2013. 131 patients were diagnosed with PGIL, representing an annual incidence rate of 22.42/100,000, compared to 35.87/100,000 in the overall Israeli population. Both incidence rates did not significantly change during the study period. The median age was 66 years, and the most common presentation was in the stomach (49.6%) and oral cavity (18.3%). Histologically, diffuse large B cell lymphoma (DLBCL) was predominant (55.0%). Most patients (66.4%) had early stage disease. Only T-cell lymphoma showed a male predominance (14.7% versus 5.4%, P=0.008). Fifty patients (44.2%) had H. pylori testing, and 35 (70.0%) were positive. Of these, 91.4% received eradication treatment, and 57.1% were negative thereafter.Most patients received CHOP or RCHOP protocols (16.0% and 48.1%, respectively). Complete response was achieved in 53.4%. Median follow-up was 48 months, and 62 patients (47.3%) died during the study period. Liver involvement had a worse prognosis, (33.0% 5-year survival) compared to upper and lower GI disease(70.5% and 46.8% respectively, P=0.003 for the comparison between liver and other locations). T-cell lymphoma had worse survival (11 months vs. not reached, P=0.003). This study demonstrates the incidence, and clinical characteristics of PGIL in the Negev region. It is important to identify disease characteristics, thus facilitating better disease detection and prognostication.

Development and Validation of Prognostic Nomograms for Patients with Primary Gastrointestinal Non-Hodgkin Lymphomas

The objective of this study was to construct and authenticate nomograms to project overall survival (OS) and cancer-specific survival (CSS) in primary gastrointestinal non-Hodgkin lymphomas (PGINHL). Suitable patients were chosen from the Surveillance, Epidemiology and End Results database and Wannan Medical College Yijishan Hospital. The Cox regression model was used to acquire independent predictive factors to develop nomograms for projecting OS and CSS. The performance of the nomograms was validated using the Harrell'sconcordance index (C-index), calibration curves, and decision curve analysis (DCA) and was compared with that of the AJCC 7th staging system. Survival curves were obtained using the Kaplan-Meier method, while the log-rank test was used to compare the difference among the groups. The C-index of the nomograms for OS and CSS was 0.735 (95% CI = 0.719-0.751) and 0.761 (95% CI = 0.739-0.783), respectively, signifying substantial predictive accuracy. These outcomes were reproducible when the nomograms were used for the internal and external validation cohorts. Moreover, assessments of the C-index, AUC, and DCA between the nomogram results and the AJCC 7th staging system showed that the former was better for evaluation and was more clinically useful. We constructed the nomogram which could predict 1-, 3-, and 5-year OS and CSS of patients with PGINHL. Our nomogram showed good performance, suggesting that it can be used as an efficacious instrument for predictive assessment of patients with PGINHL.

Management of Primary Gastrointestinal Non-Hodgkin Lymphoma with Lenalidomide

Primary gastrointestinal non-Hodgkin lymphoma is a heterogeneous malignancy with limited data to guide management. We analyzed the clinical characteristics and treatment outcomes of patients with primary gastrointestinal non-Hodgkin lymphoma treated with or without lenalidomide in a single-center patient cohort. The Kaplan-Meier method was used for survival analysis. The log-rank test was used to perform univariate survival analysis, and Cox multivariable analysis was carried out to analyze significant (P &lt; 0.05) factors from the univariate analysis. The cohort included 219 patients, of whom 140 (64%) had primary gastric lymphoma and 79 (36%) had primary intestinal lymphoma. Most tumors (205; 93%) were composed of predominantly B-cell lymphoma; diffuse large B-cell lymphoma was the most common pathologic type for both primary gastric lymphoma and primary intestinal lymphoma. Univariate analysis showed that lesion location, age, clinical stage, and sex were not associated with overall survival, but MYC rearrangement, tumor cell type, international prognostic index score, and malignant degree were associated with prognosis. Multivariable analysis showed that MYC rearrangement and tumor cell type were independent prognostic factors. The OS and PFS of patients with MYC rearrangement were shorter than that of patients without MYC rearrangement indicating that MYC rearrangement was associated with decreased survival. Neither overall survival nor progression-free survival differed between patients who received chemotherapy with surgery and those who received chemotherapy without surgery, but patients who received surgery alone had a poor prognosis. Surgery was mainly conducted to relieve tumor-related complications or to make the diagnosis. For patients with invasive B-cell lymphoma with MYC rearrangement, the addition of lenalidomide (25 mg daily, days 1-21) to chemotherapy were given. Both of the OS and PFS of patients with lenalidomide were prolonged compared with patients without lenalidomide indicating that lenalidomide could improve the prognosis of patients with invasive B-cell lymphoma with MYC rearrangement. Keywords: primary gastrointestinal lymphomas, lenalidomide, prognosis Disclosures No relevant conflicts of interest to declare.

Primary Pediatric Non-Hodgkin Lymphomas of the Gastrointestinal Tract: A Population-based Analysis.

The aim of this study was to present the clinical characteristics, natural history and survival outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) in the pediatric population. Surveillance, Epidemiology, and End Results (SEER) database was queried for patients aged 0 to 19 years with PGINHL between 1973 and 2014. A total of 452 cases were identified [mean age 11.0 (±5.1)] years, whites 84.1%, males (76.5%). The majority of tumors were noted in the small bowel (SB) (47.6%), followed by large bowel (LB) (28.5%) and the stomach (10.0%). Overall, the most common histological subtype was Burkitt lymphoma (51.8%), followed by diffuse large B-cell lymphoma (DLBCL) (26.1%). Mean overall survival (OS) of the entire cohort was 33,33 years with a 5-yr, 10-yr and 30-yr survival rate of 86%, 86% and 79%, respectively. Large bowel tumors had the best long-term survival rates whereas; gastric tumors had the worst with 30-yr survival rate 84% and 74%, respectively. Overall, 328 (72.6%) patients received surgery. No significant survival difference was noted between patients who underwent surgery and those who did not. This study presents the largest dataset of pediatric PGINHL and describes the clinical features and outcomes of these patients in addition to summarizing the literature.

3223 Knot in the Stomach: Metastatic DLBCL Disguised as an Ulcer

INTRODUCTION: Early primary gastrointestinal non-Hodgkin's lymphomas can be difficult to diagnose and can be mistaken for diseases such as Crohn's disease or intestinal tuberculosis. We present a 73-year-old patient who had large duodenal bulb ulcer on endoscopy that resulted in metastatic DLBCL. CASE DESCRIPTION/METHODS: A 73-year-old female with history of osteoporosis, Vitamin B12 deficiency, and leukopenia presented to her primary care physician complaining of feeling knot in upper abdomen for 1 month. She felt the knot was getting progressively bigger with mild abdominal discomfort. She had also complained of early satiety, abdominal bloating, and weight loss of 3-4 pounds in past few months. She denied diarrhea or blood in the stools. Physical exam was significant for minimal distension with prominent palpable pass in right upper abdomen with tenderness to palpation and no lymphadenopathy. Labs showed WBC 4.0, Hb 11.6, Plt 417, Alkaline Phosphatase 235, Alb 3.3. CT scan of abdomen pelvis showed circumferential mass like thickening along gastric antrum, mesenteric implants, and periaortic lymphadenopathy concerning for gastric carcinoma or lymphoma. She was referred to oncologist and gastroenterologist for evaluation with upper endoscopy. EGD showed large duodenal bulb ulcer with necrotic base and small ulcer in antrum. Duodenal biopsy showed newly diagnosed stage IV Diffuse Large B-Cell Lymphoma that also involved gastric, gallbladder, and pancreas. She completed 3 cycles of R-CHOP chemotherapy and was started on high-dose methotrexate for CNS prophylaxis. She had Whipple procedure done after leak of gastrografin and noted to have perforated duodenum. DISCUSSION: Diagnosis of primary GI lymphoma is difficult as it can be nonspecific and often benign gross appearance on endoscopy or colonoscopy. The duodenum represents roughly 6-8% of sites involving small intestine lymphoma. DLBCL of the intestine treated with surgery plus CHOP or R-CHOP chemotherapy has very good prognosis. Early diagnosis and treatment is crucial due to the aggressive nature of this malignancy.

Gastrointestinal non-Hodgkin lymphomas.

Although gastrointestinal (GI) tract is the most common extranodal site involved in non-Hodgkin lymphoma (NHL), primary gastrointestinal NHL (gNHL) is a rare problem which concerns about 10-15% of NHL patients and 30-40% of extranodal NHL patients. Lymphoid neoplasms may consist of mature B, T and (less commonly) extranodal NK/T cells. The most common diagnoses are diffuse large B-cell lymphoma and marginal zone lymphoma (MALT), but many other lymphomas may be found in the GI tract. There are a few well-known risk factors of gNHL and some of them affect treatment. The most frequent sites of occurrence are the stomach followed by small intestine and ileocecal region. In the last 2 decades, there has been a rapid development in the diagnosis, staging and management of GI lymphoma, but still some of such lymphomas, especially T-cell ones, are a therapeutic challenge. In this review, we present clinical and pathological features of GI lymphomas. We also describe the current status in diagnosis and treatment.

Evaluation of 22 Primary Gastrointestinal Lymphoma Patients.

Primary gastrointestinal non-hodgkin lymphomas (PGI-NHL) are uncommon diseases with treatment modalities including chemotherapy, surgery, and radiotherapy. Our aim is to analyze the demographic and clinical features and treatment results of PGI-NHL. 286 patients diagnosed with lymphoma who referred to Ataturk University Medical Faculty Hospital between July 2001 and April 2014 were surveyed retrospectively and 22 (7.6%) PGI-NHL cases whose primary lesions were in gastrointestinal system were included. Mean age was 47 (min.25-max.77) and 14 (63.6%) of them were men. The origin was determined as small intestines (50%), stomach (31.8%) and colon (18.2%), respectively. The most common complaint and pathologic subtype were abdominal pain (68.2%) and diffuse large B cell lymphoma (86.4%), respectively. The Lugano Classification was as follows: stage 1 (18.2%), stage 2 (59.1%), and stage 4 (22.7%). Surgery and chemotherapy were administered to 40.9% of patients. Complete and partial response and disease progression were established in 72.1%, 4.5% and 13.6% of the patients, respectively. Mean survival time was 99.6±16 months. Mean overall survival time was determined significantly longer in small bowel group than gastric group (119±15 vs. 50±24 months) (p=0.039). Age, gender, Eastern Cooperative Oncology Group performance status, International Prognostic Index, stage, histological type, tumor size, LDH level, albumin level, Hemoglobin level and treatment options were not associated with survival. Demographic and clinical characteristics of our series were similar with Middle Eastern and African countries. Optimal treatment options or prognostic factors for PGI-NHL are not clear. There is a need for randomized prospective studies including large number of patients and long follow-up period.

Primary Gastrointestinal Non-Hodgkin Lymphoma Diagnosed after Emergency Surgery

Primary Gastrointestinal Non-Hodgkin Lymphoma Diagnosed after Emergency Surgery

Clinical analysis of Primary Gastrointestinal Non-Hodgkin's Lymphoma.

Objective:To study the clinical characteristics and prognostic factors of survival for patients with primary gastrointestinal non-Hodgkin’s lymphoma (PGI-NHL).Methods:A retrospective analysis was performed for 104 PGI-NHL patients who were admitted in Baoding First Central Hospital from July 2003 to January 2014.Results:There were 58 males and 46 females. The median age of onset was 53 (15-83) years old. In terms of pathogenic sites, there were 51 gastric cases (49.00%) and 53 intestinal cases (51.00%), with the median survival of 35 (1-130) months. The 1-, 3- and 5-year overall survival (OS) rates were 88.40%, 80.70% and 78.80%, respectively. The factors influencing the progression-free survival (PFS) and OS rates were studied by univariate and multivariate analyses. The PFS and OS rates of patients with B-cell PGI-NHL were significantly higher than those of patients with T-cell PGI-NHL (P<0.05). The PFS and OS rates of patients with primary gastric lymphoma were significantly higher than those of patients with primary intestinal lymphoma (P<0.05), but the data were not associated with Ann Arbor stage or LDH level (P>0.05). Compared with non-surgical patients, only patients with intestinal lymphoma benefited from surgery (P<0.05).Conclusion:The pathogenic site and pathological type are risk factors that affect the survival of PGI-NHL patients, and chemotherapy should be given the first priority for patients with primary gastric lymphoma.

Analysis of Clinical Prognosis of 50 Cases of Primary Gastrointestinal Non-Hodgkin's Lymphoma

To analyze the clinical pathologic characteristics, diagnosis, treatment and outcome of patients with primary gastrointestinal non-Hodgkin's lymphoma(PGI-NHL). The clinical and pathological features of 50 cases of PGI-NHL were analyzed retrospectively, the Kaplan-Meier was applied to estimate the survival time of all the patients. The median age of patients was 58 years old, the cases of male patient were more than that of femal. The main clinical symptoms included pain and discomfort. The patients of Ⅰ-Ⅱstage accounted for 66%, DLBCL was most common. The clinical and pathological features were not significantly different between gastric and intestinal lymphoma. In 58% of the patients, surgery was the first choice for treatment. The median survival time was 74 months. The OS rates at 1-, 3- and 5-year were 78%, 65.9% and 61.8% respectively. Log-rank univariate analysis showed that age, sex, ECOG score, B symptoms, disease location and treatment methods all did not relate with OS, however, IPI, stage, LDH, cell phenotype and pathological type closely related with the OS. As lacking characteristic clinical manifestations of PGI-NHL, the DLBCL is the most common type. The prognosis of B cell lymphoma is significantly better than that of T cell lymphoma. The prognosis of PTCL is the worst.

Primary small intestinal non-Hodgkin lymphoma diagnosed after emergency surgery.

The aim of this study was to investigate clinical manifestation, diagnosis, treatment, and prognosis of patients with primary gastrointestinal non-Hodgkin lymphoma (PGI NHL), whose initial presentation was bowel obstruction or perforation. Data of patients who underwent surgical intervention due to radiological evidence of perforation or intestinal obstruction and were subsequently diagnosed with intestinal lymphoma at Baskent University hospitals between January 2007 and November 2014 were examined retrospectively. Medical records, clinical history, symptoms, pathological reports, and treatment modalities were analyzed. Study population comprised 17 patients (8 male, 9 female) with PGI NHL and mean age of 52±20.2 years. Symptoms reported by the patients were abdominal pain, nausea, vomiting, weight loss, and loss of appetite. All 17 patients underwent surgical treatment; 12 also received postoperative chemotherapy. Most common pathological subtype was diffuse large B-cell lymphoma (70.5%). Mean follow-up time was 26 months (range: 1-69 months) and 5-year survival rate was 64.3%. Initial presentation of PGI NHL may be obstruction with or without perforation; clinicians and surgeons should keep this in mind while assessing patient with bowel obstruction, and particularly patient in fifth decade of life.

The Role of Surgery in the Clinical Management of Primary Gastrointestinal Non-Hodgkin's Lymphoma

Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) is a heterogeneous family of tumors, with treatment modalities including chemotherapy, surgery, and radiotherapy. Because the role of surgery in PGINHL remains disputed, this study aims to assess the impact of operative resection on survival. We used a pathology database to identify all cases of PGINHL diagnosed at a single academic-affiliated medical center from 1988 to 2013. Demographic and clinical data were abstracted from the medical record. We summarized the clinical courses of patients with PGINHL and then performed a survival analysis to compare overall and disease-free survival, stratified by demographic and clinical variables. We identified 33 patients diagnosed with PGINHL during the study period. Of 29 who subsequently received treatment at the institution, 15 initially underwent chemotherapy, 10 underwent surgical resection, and 4 underwent surgery for other reasons such as diagnosis without resection or management of disease complications. Three patients suffered surgical complications and two of these patients died. We found no difference in overall survival between patients receiving surgical resection and patients managed initially with chemotherapy. This case series supports a continued role for surgical resection in the management of patients with PGINHL, though anticipated benefits should be weighed against the risk of complications.

Primary Gastric Burkitt's Lymphoma

The primary gastrointestinal non-Hodgkin’s lymphoma, although rare, is among the most common extra-nodal lymphomas, considering that gastric lymphomas are more common than intestinal lymphomas. Burkitt’s lymphoma (BL) is an aggressive form of B-cell lymphoma that is typically endemic in Africa, while non-endemic cases are found in the rest of the world. Primary gastric BL is extremely rare and only around 50 cases have been reported worldwide. Here we present the case of a young HIV-negative male, who was referred to our department with a stage IV gastric BL. He was planned for palliative chemotherapy, but after the first cycle of chemotherapy he succumbed to the progression of the disease.

Clinical characteristics of 104 patients with primary gastrointestinal non-Hodgkin lymphoma

To analyze the clinical characteristics and prognostic factors in patients with primary gastrointestinal non-Hodgkin lymphoma (PGI-NHL). The pathological data of 104 PGI-NHL patients diagnosed in our hospital between 2003 and 2013 were analyzed retrospectively. 104 patients with PGI-NHL were enrolled, including 58 males and 46 females with a median age of 53 (range:15 to 83) years. 51(49%) cases derived from stomach and the other 53 (51%) patients originated in intestine. The median survival was 35 (range:1 to 30) months. The 1- year, 3- year, and 5-year overall survival (OS) were 88.4%, 80.7% and 78.8%, respectively. Both progress free survival and OS were significantly higher in B-cell GPI-NHL than T- cell GPI-NHL (P=0.000). The survival of gastric NHL is superior to intestinal NHL. The sites of origin and pathological type are prognostic factors for survival in PGI-NHL patients.