Effect of malnutrition based on Global Leadership Initiative on Malnutrition criteria on the outcomes of primary gastrointestinal lymphoma patients / 中华临床营养杂志

Objective:To investigate the impact of malnutrition diagnosed with Global Leadership Initiative on Malnutrition (GLIM) criteria on the outcomes of patients with primary gastrointestinal lymphoma (PGIL).Methods:Patients with PGIL admitted into Gansu Provincial People's Hospital from January 2014 to July 2022 were retrospectively enrolled. Nutritional risk screening was conducted using Nutritional Risk Screening 2002 (NRS 2002) scale, and malnutrition was diagnosed as per GLIM criteria. Kaplan-Meier survival analysis and multivariate Cox regression analysis were performed to investigate the effect of malnutrition as per GLIM criteria on the outcomes of PGIL patients.Results:A total of 82 patients were included. The phenotypic parameters, including body mass index (BMI), arm circumference, leg circumference and grip strength, were at significantly lower levels in the 28 malnourished patients, compared with the other non-malnourished patients. The median overall survival of patients with malnutrition as per GLIM criteria was 10 months, while that of patients without malnutrition was 41 months, showing significant differences between groups. The univariate analysis revealed that age, loss of muscle mass, tumor stage based on Lugano classification and malnutrition as per GLIM criteria were the impacting factors for survival in patients with PGIL. The multivariate analysis further demonstrated that tumor stage based on Lugano classification and malnutrition as per GLIM criteria were the independent impacting factors for survival in patients with PGIL.Conclusion:Malnutrition based on GLIM criteria is an independent risk factor for unfavorable outcomes in patients with PGIL and could be utilized as a prognostic indicator.

GASTRO-INTESTINAL LYMPHOMA PRESENTING AS INTUSSUSCEPTION

Extranodal Lymphomas are most commonly located in gastrointestinal tract. The most common cause of small intestinal obstruction in children is intussusception. However GI lymphomas are a rare cause of intussusception. So we are reporting a case of extranodal lymphoma in a female child presenting as intussusception of small intestine. a 9 years old female child presented with features of subacute intestinal obstruction. On examination a lump was felt in the abdomen. On further evaluation, a computed tomography (CT) revealed a possibility of lymphoma. The bowel segment was excised and sent for histopathological examination. On gross examination a growth was seen along with satellite lesion. 10 lymph nodes were also identified. Representative sections were taken. Microscopic examination showed the presence of medium size to large size lymphoid cells. After immunohistochemical staining a diagnosis of Non Hodgkins Lymphoma (Extranodal Marginal Zone) was made. 1 lymph node was positive for tumour invasion while other 9 were showing reactive hyperplasia. Since both lymphomas and intussesception are common in pediatric age group, lymphoma should always be kept as a differential diagnosis while dealing with a case of intussusception in pediatric age group.

Primary extraperitoneal rectum lymphoma in AIDS patient / Linfoma primário de reto extraperitoneal em paciente SIDA

ABSTRACT Introduction The gastrointestinal lymphoma can be classified in primary or secondary, and this is important regarding diagnosis and subsequent treatment. Primary gastrointestinal lymphoma of the rectum is rare and therefore lacks data in medical literature. Its incidence has been increasing and that fact may be related to a higher incidence in immunosuppressive therapy and immunosuppressive diseases (such as AIDS). Metodology 19 articles have been reviewed, searched online on the Scielo and PubMed databases. The goal was to increase data available regarding this pathology and improve its therapy. Discussion Primary GI lymphoma of the rectum presents as hematochezia, rectal pain, change in bowel habits. PET/CT is the first choice exam to pursue investigation; however abdominal CT and MRI reveal sufficient information and are much more available in daily practice. Plasmablastyc lymphoma is an aggressive subtype and is usually associated with AIDS patients. There are no available treatment protocols for this specific type of lymphoma and colonic lymphoma's therapy is usually used for this patient (such as ECHOP and CHOP). Conclusion As rare as this pathology is, this article aims to improve the available data and provide useful information regarding diagnosis and therapy.

RESUMO Introdução O linfoma do TGI pode ser dividido entre primário e secundário, com importância diagnóstica e terapêutica. O linfoma primário de reto é patologia rara, pouco relatada em literatura médica. Sua incidência tem aumentado e possivelmente esse fenômeno esteja associado ao aumento no numero de pacientes com imunossupressão (seja por SIDA ou drogas imunossupressoras). Metodologia Foram revisados 19 artigos nas bases de dados Scielo e PubMed, com o objetivo de aumentar o número de relatos dessa patologia e consequentemente expandir o conhecimento disponível, visando melhorar a terapêutica e, principalmente, o diagnóstico desse tipo de linfoma. Discussão Quando o linfoma tem seu sítio primário no reto, as principais manifestações são sangramento, dor retal, tenesmo e mudança nos hábitos intestinais (diarreia ou constipação). O exame de investigação de escolha é o PET/CT, porém a TC e RNM fornecem as informações necessárias e são mais disponíveis na prática clínica. O linfoma plasmablástico é um subtipo bastante agressivo e associado aos pacientes com SIDA. Não existem ainda protocolos definidos para o tratamento do linfoma primário de reto, sendo optado por seguir a mesma terapêutica dos linfomas de cólon com esquemas EPOCH e CHOP. Conclusão Por se tratar de patologia rara e pouco descrita na literatura, espera-se que este relato contribua na formação de protocolos de tratamento específicos.

Clinical characteristics of primary extranodal versus nodal diffuse large B-Cell Lymphoma: A retrospective cohort study in a cancer center

Background The outcome of patients with primary extranodal diffuse large B-cell lymphoma (PE-DLBCL) varies according to the primary site involved. Primary gastrointestinal, breast, bone, craniofacial, and testicular DLBCL are rare extranodal manifestations of DLBCL. Objective The objective of the study was to describe the clinical course of patients with PE-DLBCL disease in a referral cancer center. Results From 637 patients, 51 (8.77%) were considered as having PE-DLBCL (25 gastrointestinal, 12 craniofacial, 6 breast, 5 bone, and 3 with primary testicular DLBCL). Complete remission was higher in all PE-DLBCL sites (100% in testicular, 92.6% craniofacial, 83.3% breast, 80% bone, and 80% gastrointestinal) compared with 73.3% in nodal DLBCL. Although 2 cases with breast PE-DLBC relapsed, they achieved a complete response with chemotherapy. The overall survival at 5 years was 100%, 80%, 78%, 58%, 58%, and 62% for patients with primary breast, primary bone, gastrointestinal, primary craniofacial, primary testicular, and nodal DLBCL, respectively. Conclusions PE-DLBCLs constitute rare, primary sites of lymphoproliferative disorders in most cases, with localized disease and good prognosis. They require a combined chemoimmunotherapy with radiotherapy in most cases to improve local and systemic disease.

Extranodal NK/T-cell lymphoma mimicking Crohn’s colitis

@#Introduction: Extranodal NK/T cell lymphoma is a rare tumour, typically involving the upper aerodigestive tract. Even rarer is primary extranasal disease involving the skin, testis, soft tissue and gastrointestinal tract. Case Report: We report a case of a 46-year-old Chinese male who presented with six months history of abdominal pain, weight loss and rectal bleeding. Diagnostic colonoscopy revealed multiple aphthous ulcers within the ileo-caecal region and distal transverse colon, separated by normal mucosa, mimicking skip lesions of Crohn’s colitis. Computer topography (CT) scan of the abdomen showed multiple circumferential thickenings involving predominantly the right colon. A clinical diagnosis of colonic Crohn’s disease with possible perforation was made. An extended right hemicolectomy was performed due to uncontrolled rectal bleeding. Histopathology examination of the colon showed infiltration by malignant lymphoid cells associated with necrosis, angiocentricity and angiodestruction. Immunohistochemical studies confirmed T-cell monoclonality, presence of cytotoxic granules and Epstein-Barr virus (EBV) infection. A diagnosis of extranodal NK/T cell lymphoma of the colon was made. Discussion: These findings highlight that colonic NK/T cell lymphoma may clinically mimic other benign inflammatory lesions and should be one of the differential diagnoses in patients presenting with gastrointestinal lesions. The final diagnosis is only possible with appropriate histological and immunohistochemical studies.

Linfoma primario del intestino delgado: reporte de un caso y revisión de la literatura / Primary Lymphoma in the Small Intestine: A Case Report and Literature Review

El tracto gastrointestinal es el sitio más frecuente de presentación del linfoma no Hodgkin (LNH) extraganglionar. Sin embargo, los linfomas primarios del tracto gastrointestinal son tumores raros y es mucho más frecuente la afectación de este tracto de manera secundaria en el curso de la enfermedad. Representan del 1% al 4% de los tumores malignos del tracto gastrointestinal, aunque tienen un curso, manejo y pronóstico muy diferente de los adenocarcinomas, por lo que es importante conocerlos y tenerlos en mente como un diagnóstico diferencial posible en el ejercicio clínico diario. Afectan más a los adultos jóvenes, con una mayor frecuencia en hombres (1). Reportamos el caso de una mujer de 47 años de edad con linfoma primario del intestino delgado, diagnosticado luego de múltiples consultas por síntomas abdominales y revisamos la literatura al respecto

The gastrointestinal tract is the most frequent site of non-Hodgkin’s lymphoma (NH) outside of the lymph nodes themselves. This tract is much more frequently compromised by tumors secondary to primary disease elsewhere in the body than by primary lymphomas of the gastrointestinal tract itself which are rare. They account for only one to four percent of malignant tumors of the gastrointestinal tract. Their development and prognoses are quite different from those of adenocarcinomas, hence their management must differ as well. It is important to understand them and keep them in mind in differential diagnosis in daily clinical practice. Young adults are most frequently affected, and men are more frequently affected than are women. We review the literature and report the case of a 47 year old woman with primary small bowel lymphoma that was diagnosed after several consultations due to abdominal symptoms

Primary gastrointestinal lymphomas in children: An experience of 12 years from a tertiary care center of North India.

BACKGROUND AND AIM: Lymphomas are among the dominant solid tumors in children and primary gastrointestinal lymphomas (PGILs), although rare, are the most common extranodal lymphomas and the most common malignancies affecting the gastrointestinal tract in children. This study was undertaken to analyze childhood PGIL with reference to clinical presentation, anatomic distribution, histopathologic, and immunohistochemical (IHC) characteristics. MATERIALS AND METHODS: In this 12 year combined retrospective and prospective descriptive study, all the cases of PGIL in children were selected according to Dawson’s criteria. RESULTS: A total of 11 cases were found which included 9 boys and 2 girls (male:female ‑ 4.5:1) ranging in age from 1 to 14 years (mean 6.6 years). Abdominal pain (81.8%) and intestinal obstruction (63.6%) were the most common presenting features. Grossly, most of the lesions were ulcero‑infiltrative (72.7%) and involved the terminal part of the ileum (36.4%) and ileocecal region (27.3%) most commonly. Histopathologically and IHC, all the cases were high‑grade lymphomas of diffuse large B‑cell type except for one case of mucosa‑associated lymphoid tissue lymphoma. No case of Burkitt’s lymphoma was found. CONCLUSION: PGILs are an important cause of morbidity and mortality in children worldwide with considerable variation in their clinicopathological features and treatment modalities. Only some studies are available in literature for comparison. Further studies are required to define the genetic and molecular basis of the different histopathological pattern found in our setting.

Endoscopic Findings of Enteropathy-Associated T-Cell Lymphoma Type II: A Case Series

Enteropathy-associated T-cell lymphoma (EATL) is a rare extranodal T-cell lymphoma arising from the intestine. Two types of EATL have been reported. In contrast to the classic EATL type I, EATL type II occurs sporadically, is unrelated to celiac disease, and comprises 10% to 20% of all EATL cases. A total of five cases of EATL type II were diagnosed at our clinic from January 2009 to September 2012. Four of the five patients were diagnosed with the help of endoscopy. Among the four patients, two of the cases involved both the small and large intestines, whereas in the other two patients, EATL was limited to the small intestine. Common endoscopic findings included innumerable fine granularities (also called mosaic mucosal patterns) and diffuse thickening of the mucosa with a semicircular shallow ulceration in the lesions of the small bowel. In contrast, the endoscopic findings of the colon were nonspecific and could not distinguish EATL type II from other diseases. There are only few published reports regarding the representative endoscopic findings of EATL. Here, we present the clinical and endoscopic findings of four cases of EATL type II diagnosed by endoscopy.

Therapeutic comparison of Surgery combined with chemotherapy and chemotherapy alone for Primary Gastrointestinal Lymphoma: A single center study / 고신대학교의과대학학술지

OBJECTIVES: There is still no consensus on the optimal treatment for primary gastrointestinal lymphoma (PGIL). The aim of this study was to compare surgery combined with chemotherapy and chemotherapy alone in PGIL. METHODS: We retrospectively reviewed and analyzed the treatment outcomes of 107 patients with primary gastrointestinal lymphoma diagnosed between March 1999 and December 2009 at Kosin University Gospel Hospital. Patients were divided into two groups: 35 patients who underwent surgery combined with chemotherapy (group A) and 72 patients who were treated with chemotherapy alone (group B). And we analyzed prognostic factors associated with short survival. RESULTS: The 5-year progression free survival rates (PFS) of group A and B were 86.7% and 66.1%, respectively (P = 0.037), while the 5-year overall survival rates (OS) were 86.8% and 68.4%, respectively (P = 0.129). In multivariate analysis, Both PFS and OS were not changed by treatment strategies (surgery combined with chemotherapy or chemotherapy only). The international prognostic index (IPI) was the only independent predictive factor for PFS. CONCLUSIONS: In our study, surgery combined with chemotherapy and chemotherapy only make no difference of survival rate. And further randomized prospective studies are needed to confirm a treatment strategies at improving survival outcomes in PGIL patients.

Comparison of TNM and Lugano staging systems in predicting 5-year survival rate of primary gastrointestinal lymphoma patients / 中国肿瘤临床

Objective:To assess the survival-predictive value of TNM and Lugano staging systems in patients with primary gastro-intestinal lymphoma (PGL). Methods:A total of 73 patients with PGL were recruited from February 2001 to August 2013. All patients were diagnosed according to the TNM and Lugano staging systems. Five-year survival rate was used as the major clinical outcome. Sur-vival curves were plotted using the Kaplan–Meier method and analyzed with the log-rank test. The prognostic value of different vari-ables for clinical outcomes was assessed using the Cox multiple regression model. Results:The median follow-up time of surviving pa-tients was 42.4 months (range:1.3-158.6 months). The estimated 5-year overall survival rate was 77.82%. When diagnosed with the TNM system, the 5-year survival rates in stagesⅠ,Ⅱ,Ⅲ, andⅣwere 100%, 90.0%, 67.4%, and 22.2%, respectively (χ2=17.7956, P=0.0005). When staged by the Lugano system, the 5-year survival rates in stagesⅠ,Ⅱ,ⅡE , andⅣwere 100%, 100%, 70.7%, and 46.2%, respectively (χ2=15.6776, P=0.0013). Cox analysis showed that the invasion depth (T) (P=0.0181) and metastasis (M) (P=0.0031) were covariates that were prognostically significant for the overall survival. Conclusion:The TNM staging system is more ac-curate than the Lugano system in predicting the 5-year survival rate of patients with PGL.

Primary gastrointestinal lymphomas - A study of 81 Cases from a Tertiary Healthcare Centre.

Purpose: Retrospective analysis of 81 routinely diagnosed gastrointestinal (GI) lymphoma to illustrate clinicopathological and immunohistochemical characteristics with predisposing condition. Materials and Methods: Age, sex, site, tumour stage, associated pathological features like lympho-epithelial lesion (LEL), atrophic gastritis (AG), intestinal metaplasia (IM) and enteropathy changes were analysed. Requisite immunohistochemical panel was applied wherever needed. Results: There were 55 male and 26 female patients with median age of 54.5 years. Site wise distributions were stomach 40, small intestine 22, colon 4, cecum 2, ileocecum 3, esophagus 1 and multiple sites 9. Histological subtypes were mucosa associated lymphoid tissue lymphoma (MALTOMA) 48, diffuse large B cell lymphoma (DLBL) 21, T cell lymphoma 9 [5 anaplastic large cell lymphoma (ALCL) and 4 enteropathy associated T cell lymphoma (EATL)], immunoproliferative small intestinal disease (IPSID) 2 and follicular lymphoma 1. LEL was present in 31 cases. Of the 19 AG, 8 had associated IM, and 1 case each had associated H Pylori infection and neuroendocrine tumor. Enteropathy was observed in 4 EATL, and one case each of DLBL and high grade MALTOMA. Giardia infection was present in 1 low grade duodenal MALTOMA. Of the 24 resected specimens, 16 were stage IE, 7 stage IIE and 1 stage IV (Mushoff's staging). Conclusion: Primary GI lymphoma was frequently observed in 6 th decade of life with male preponderance. Stomach was the commonest site and high grade MALTOMA being the commonest histological variant. Isolated colonic involvement and intestinal perforations were not infrequent. Rare variants like ALCL and follicular lymphomas were also observed.

Primary gastrointestinal non-Hodgkin lymphoma: a retrospective study of 51 cases / 白血病·淋巴瘤

Objective To understand the clinical characteristics and treatment outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) and analyze the differences between T-cell and B-cell lymphomas.Methods.The characteristics of 51 PGINHL patients were analyzed regarding to their clinical manifestations,diagnosis,treatments and outcomes.Results 51 cases of PGINHL meeting the WHO(2008) criteria were identified.The median age of the patients at the time of diagnosis was 56 years old and the male ∶ female ratio was 1.44∶1,35 cases (68.7 ％) had B-lineage and 16 cases (31.3 ％) had T-cell lineage lymphomas.Compared to those with B-cell lymphoma,patients with T-cell lymphoma presented with a greater incidence of such symptoms as hematochezia,diarrhea and night sweating (P ＜ 0.05).After eliminating MALT lymphoma,prognosis of T-cell lymphoma and B-cell lymphoma had no significant difference.Conclusion In PGINHL cases,B-cell lymphomas appeare to be more common and have better prognosis than T-cell lymphomas.

Linfoma anaplásico de grandes células T com envolvimento do cólon: relato de caso / Anaplastic large T-cell lymphoma with involvement of the colon: case report

JUSTIFICATIVA E OBJETIVOS: Linfoma anaplásico de grandes células é um tipo raro de linfoma não-Hodgkin (LNH) originado de linfócitos T maduros. O diagnóstico é feito a partir de quadro morfológico típico e de um imunofenótipo de células T positivo para CD30. As lesões gastrintestinais são os tipos mais comum de linfomas extranodais primários, representando cerca de 5% a 10% de todos os LNH, sendo mais comum no fenótipo de células B. O objetivo deste relato foi descrever um caso com envolvimento primário do cólon, evoluindo rapidamente para a fase terminal, com falência múltipla de órgãos e sistemas. RELATO DO CASO: Paciente do sexo masculino, 50 anos, admitido no serviço de Clínica Médica do Hospital Santa Casa do Rio Grande (ACSCRG) com história de dor abdominal inespecífica há dois meses. Havia realizado endoscopia digestiva alta e recebeu tratamento, ao final do qual desenvolveu lesões cutâneas eritematosas difusas, que motivaram sua admissão para investigação.Febril, com abdômen levemente distendido e fígado palpável. Na videocolonoscopia identificou-se placas arredondadas de mucosa escurecida com 4 a 6 mm em meio à mucosa normal, estendendo-se até o íleo terminal. CONCLUSÃO: O linfoma anaplásico de grandes células é raro e infrequente em descrições e revisões. Tipo raro de LNH apresenta-se com comportamento agressivo, em estágio avançado e frequentemente com localização extranodal. A localização gástrica é a mais encontrada, seguida pelo intestino delgado.

BACKGROUND AND OBJECTIVES: Anaplastic large cell lymphoma is a rare type of non-Hodgkin lymphoma originated from mature T lymphocytes. The diagnosis is made from the recognition of typical morphological features and a CD30-positive T-cell immunophenotype. The gastrointestinal lesions are the most common type of primary extranodal lymphomas, accounting for about 5% to 10% of all NHLs, being more common in B-cell phenotype. The purpose of this report describes a case with primary involvement of the colon, rapidly progressing to the terminal phase, with the multiple organ dysfunction syndrome.CASE REPORT: A 50-year-old man admitted to the Internal Medicine ward at the, Hospital Santa Casa do Rio Grande (ACSCRG) with a history of nonspecific abdominal pain for two months. Endoscopy had been undertaken and he received treatment, at the end of which he developed diffuse erythematous skin lesions, which motivated admission for investigation. Investigation,feverish, with slightly distended abdomen and palpable liver. Through colonoscopy it was identified rounded plaques of darkened mucosal with 4 to 6 mm among the of normal mucosa, extending to the terminal ileum. CONCLUSION: Anaplastic large cell lymphoma is rare and infrequent in descriptions and reviews. Rare type of non-Hodgkin lymphoma (NHL), this disease presents itself with an aggressive course, advanced stage, and often extranodal location. The gastric location is the most common, followed by the small intestine.

Linfoma primário de cólon: relato de caso / Primary colorectal lymphoma: case report

O linfoma colorretal primário é uma doença rara (0.2 a 0.6 por cento de todas as neoplasias colônicas), apresentando pior prognóstico quando comparado com o linfoma gástrico primário ou com o adenocarcinoma do cólon. É uma doença com sintomatologia inespecífica, o que dificulta o diagnóstico precoce. O objetivo deste relato é mostrar um caso de linfoma primário do cólon, revisar critérios diagnósticos e tratamento.

The primary colorectal lymphoma is a rare disease (0.2 to 0.6 percent of all colonic neoplasias), that has a worse prognosis than primary gastric lymphoma or colon adenocarcinoma. The poor signals makes the early diagnosis difficult. The objectives of this report is to describe a case of primary colon lymphoma, revise diagnosis criteria and treatment.

Incidencia de linfoma gastrointestinal en el hospital militar Dr. Carlos Arvelo en el lapso 2003-2008 un período de 5 años

Los Linfomas No Hodgkin del tracto gastrointestinal son los linfomas extranodales más comunes, representando entre el 30 y 70% de esta última patología constituyendo un grupo heterogéneo de tumores con diferentes características clínicas y patológicas. El estómago está lesionado de manera predominante siendo los linfomas tipo MALT los tumores de bajo grado más frecuentes en el sistema gastrointestinal, contando con 40% de todos los linfomas gástricos primarios, manteniéndose localizados por períodos prolongados sin tratamiento. Objetivos: evaluar la epidemiología de los linfomas gastrointestinales en nuestro centro. Pacientes y métodos: Análisis retrospectivo de las historias de pacientes con diagnóstico de Linfoma Gastrointestinal. Resultados: Se presentan datos clínicos e histopatológicos de 20 pacientes con diagnóstico de Linfoma Gastrointestinal tratados en el Hospital Militar "Dr. Carlos Arvelo", Caracas, Venezuela, desde 2003 a 2008. 15 hombres, 5 mujeres, con edades comprendidas entre 23 y 64 años. De ellos, 14 (70 %) se presentaron con enfermedad limitada (estadio I-II) mientras que 6 (30%) tuvieron lesión de varios órganos (hígado, páncreas, bazo, duodeno) o más de un órgano gastrointestinal, siendo clasificado como estadio IV. 11 pacientes tuvieron linfoma gástrico, 2 de páncreas, 1 hepático esplénico y de columna lumbar, 1 intestino delgado, 1 en bazo, 4 de colon, y en 5 pacientes se observaron multiples localizaciones en el sistema gastrointestinal. Dolor abdominal, hemorragia digestiva, pérdida de peso fueron los síntomas más frecuentes de presentación. El estómago fue el órgano mas frecuentemente lesionado.

Non-Hodgkin´s lymphomas (NHL) of the gastrointestinal (GI) tract are the most common extra nodal lymphomas. They represent between 30% to 70% of all extra nodal lymphomas and constitute a heterogeneous group of tumors with different clinical and pathological features. The stomach is predominantly involved. MALT type lymphomas are the most frequent low grade non-Hodgkin´s lymphomas encountered in the GI tract. They account for 40% of all primary gastric lymphomas and remain, in the majority of cases, localized for a prolonged period of time without therapy. Aim: To evaluate the epidemiology of gastrointestinal lymphomas in our Hospital. Patients and Methods: Retrospective analysis of patientÊs recorders performed at the Hospital Militar "Dr. Carlos Arvelo", Caracas, that had the diagnosis of gastrointestinal lymphoma. Results Clinical and histopathologjcal data from 20 patients presenting with GI-NHL treated from 2003 until 2008, were reviewed. 15 men, 5 women with an age range between 23 and 64 years old. Of these, 14 (70%) presented with limited disease (stage I and II), while 6 patients were found to have disease involvement of other abdominal organs (i.e., liver, pancreas, spleen, duodenum) or more than one gastrointestinal site and were therefore classified as stage IV. 11 patients presented with lymphoma in the stomach, 2 pancreatic, 1 in liver, spleen and lumbar vertebrae, 1 in the small intestine and 4 in the large bowel, while in 5 cases multiple localizations of the gastrointestinal tract were documented. Abdominal pain, gastrointestinal bleeding, weighs loose were the main presenting symptom.

Diagnosis and treatment of 81 patients with primary gastrointestinal lymphoma / 中南大学学报(医学版)

Objective To analyze the status quo of the diagnosis and treatments of primary gastro-intestinal lymphoma (PGIL) in order to improve it. Methods Eighty-one patients with PGIL were ana-lyzed retrospectively including clinical manifestations, endoscopic features, pathological features, HP in-fection, treatment, and prognosis. Results The age of patients with gastric lymphoma was (52.84±15.33) years. The age of patients with intestinal lymphoma was (42.09±15.28) years. Common symp-toms included abdominal pain (76.5%), gastrointestinal bleeding (55.6%), anemia (54.3%), abdominal mass (25.9%), hypoproteinemia (40.7%), bowel obstruction (11.1%), abdominal dis-tension, vomiting, and other non-specific gastrointestinal symptoms (32.1%), weight loss (33.3%); fever (8.6%), diarrhea (7.4%), digestive tract perforation (1.2%), constipation (1.2%), and dysphagia (1.2%). Endoscopic appearances were as follows: tumor type (67.7%), ulcer type (27.7%), and diffuse type (4.6%). Clinical diagnosis rate and endoscopic biopsy confirmation rate were 30.9% and 73.8%. MALT lymphoma accounted for 61.7% of the patients. HP detection rate was 39.5 % and positive rate was 37.5 %. A total of 69 patients received surgeries: 3 had preoperative chem-otherapy, and 34 had postoperative chemotherapy. Twelve patients had non-surgical treatment, 6 patients of whom had simple chemotherapy and HP eradication therapy, and the other 6 gave up during the treat-ment. There was no significant difference in the survival rate of Stage Ⅰ～Ⅱ patients in the surgery alone group, surgery plus chemotherapy group, and chemotherapy and HP eradication therapy group (P>0.05). The survival rate of Stage IIIⅢ～Ⅳ patients in the surgery alone group was lower than that in the other 2 groups (P<0.05). The 5-year, 3-year, and 1-year survival rate was 55.87%, 70.96%, and 96.39%, respectively. Conclusion There are no specific clinical and endoscopic features in PGIL, so the misdiagnosis rate is high. Multi-site biopsy or repeated biopsies and immunohistochemical methods can be used to raise the pathological diagnosis rate. Chemotherapy and HP eradication are recommended.

A Case of Primary Follicular Lymphoma Arising in the Rectum / 대한소화기내시경학회지

Follicular lymphoma (FL) is one of the most common non-Hodgkin's lymphomas in the United States, but it is relatively rare in Asia. FL typically arises in lymph nodes together with spleen, liver, and bone marrow involvement. So, primary extra-nodal FL without peripheral nodal involvement is rare. Histologically, it shows nodular aggregates of lymphoma cells and positivity for CD 10, CD 20 and bcl-2. Not only the stage, but also the grade is associated with the survival rate. Grade 3 FL presents a worse prognosis than does grade 1 and 2 FL and this should be treated with an anthracycline based CHOP regimen. We report here on a case of primary follicular lymphoma arising in the rectum; this was observed in a 58-year-old woman who complained of anorexia, dyspepsia and diarrhea.

A Case of Gastrointestinal Multiple Lymphomatous Polyposis with Conjunctival Involvement / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is a distinctive type of primary gastrointestinal lymphoma, characterized by multiple polyps involving long segments of the gastrointestinal tract. Because MLP has a high tendency toward extraintestinal involvement such as bone marrow, lymph node, spleen and liver, MLP can cause various clinical manifestations and has a poor prognosis. We report a case of gastrointestinal MLP, who had an unusual conjunctival involvement during the course of anti-cancer chemotherapy.

A Case of Primary Jejunal Malignant Lymphoma Associated with Nodular Lymphoid Hyperplasia / 대한소화기내시경학회지

Nodular lymphoid hyperplasia is a reaction of the intestinal lymphatic tissue to specific inflammatory stimuli and may be probably of no clinical significance, but it may evolve to primary gastrointestinal lymphoma in more severe cases. Recently, several cases of nodular lymphoid hyperplasia complicated by primary gastrointestinal lymphoma have been reported, and which suggested that nodular lymphoid hyperplasia could not be considered as simple benign colon disease any more. We also experienced a case of primary jejunal malignant lymphoma associated with nodular lymphoid hyperplasia, and report this case with a brief review of relevant literatures.

The Clinical Significance of Ann Arbor and Musshoff's Staging System in Primary Gastrointestinal Non-Hodgkin's Lymphoma-A Retrospective Analysis / 대한혈액학회지

BACKGROUND: Primary Gastrointestinal Non- Hodgkin's Lymphoma (GIL) represents 4 to 20 % of all Non-Hodgkin's Lymphoma(NHL) and gastrointestinal tract(GIT) is the most frequently involved extranodal site in NHL. It is known that the prognosis of GIL is better than that of other NHLs because of it's unique biologic behavior and anatomical location. We reviewed clinical aspects of GIL and analyzed survival data based on Ann-Arbor and Musshoff's staging system. METHODS: Sixty six cases were analyzed by age, sex, clinical manifestation, location, histology, clinical course, and two staging systems (Ann Arbor and Musshoff's modified staging). Histologies were reviewed according to REAL classification. RESULTS: The median age was 51.5 years. The most frequent gross finding was ulcerofungating lesion in upper GIL and mass lesion in lower GIL. Treatment results were as following : 76.9% of response rate, 59.5% of 5-year overall survival rate, and 54.8% of 5-year disease free survival rate. There was a significant difference of overall survival or disease free survival rate between group below stage IIE1 and above IIE2 according to Musshoff's staging system. There were no significant differences in survival between stage I and II, and between stage III and IV based on Ann Arbor staging system. CONCLUSION: There might be the necessity of discriminating localized disease (IIE1) and locally advanced lesion (IIE2) to predict the prognosis of GIL through Musshoff's staging system. Larger study will be needed to confirm the role of Musshoff's staging system.