Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

BACKGROUND/AIMS: In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings. METHODS: In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR. RESULTS: The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings. CONCLUSIONS: In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types.

Diagnostic superiority of endoscopic ultrasonography in 38 cases of primary gastric lymphoma and its value in follow-up / 中华消化杂志

Objective To evaluate the diagnostic superiority of endoscopic ultrasonography (EUS) in primary gastric lymphoma (PGL) and its value in follow-up.Methods From January 2012 to June 2015,38 patients with suspected PGL under regular gastroendoscopy,biopsy and surgery operation received EUS combined with targeted deep biopsy.T test and chi-square test were performed for statistical analysis.Results Among 50 patients suspected for PGL under regular gastroendoscopy,38 patients were confirmed pathologically.The sensitivity of EUS examination with targeted deep biopsy in PGL was 86.8％ (33/38),the specificity was 83.3％ (10/12) and accuracy was 86.0％ (43/50).The accuracy of EUS examination with deep biopsy was higher than that of regular gastroscopy,and the difference was statistically significant (86.0％ (43/50) vs 57.9％ (22/38),x2 =19.4,P＜0.05).The main endosonographic characteristics of PGL were partial or diffuse thickening of stomach wall presented with,even or uneven hypoechoic lesions and extramural enlarged lymph nodes.Compared with pathological stage after surgery,the accuracy of T and N stage of EUS was 8/8 and 7/8.The times to achieve complete remission of Helicobacter pylori (H.pylori) eradication group and H.pylori eradication group were (3.3±0.8) months and (4.6± 0.9) months,respectively,and the difference between the two groups was statistically significant (t =4.3,P＜0.05).Conclusions The detection rate of EUS combined with targeted deep biopsy is high,which could clearly indicate the depth and extent of lesion invasion and guide clinical stage and selection of therapy.EUS could effectively evaluate efficacy of PGL treatment.

Retrospective analysis of the clinical features and prognostic factors of 126 patients with primary gastric diffuse large B-cell lymphoma / 中国肿瘤临床

Objective:Primary gastric diffuse large B-cell lymphoma (PGLBCL) is a highly common subtype of extranodal non-Hodgkin lymphoma. We analyzed the disease's clinical features and prognosis to guide better treatment. Methods:We retrospectively collect-ed data from PGLBCL cases seen from January 1999 to March 2012 in one cancer center. We then analyzed the demographic character-istics, clinical stage, histological diagnosis, complications, treatment, and prognostic characteristics of such patients. Results:A total of 126 patients with median age of 49 years old (range:16-81 years) were included in the study. The male-to-female ratio was 68:58. A to-tal of 96 patients were pathologically diagnosed with pure diffuse large B-cell lymphoma (DLBCL), 27 with mucosa-assouated lymphoid (MALT) component, and 3 with plasmacytoid differentiation. Meanwhile, 90%of the patients were in the early stage of the disease. For the early-stage patients, treatment strategy included surgery+chemotherapy ± radiotherapy for 38 cases, chemoradiotherapy for 39 cases, chemotherapy alone for 37 cases, and surgery alone for 1 case. Under a median follow up of 48 months, the 4-year progres-sion free survival (PFS) and overall ourvival (OS) rate of the whole group were 75.6%and 82.7%, respectively. PFS rates for early and advanced stage patients were 77%and 41.7%(P=0.005), respectively. For the early-stage patients treated with chemotherapy alone, chemoradiotherapy, and surgery with therapy, the PFS rates were 67.3%, 77.8%, and 77.8%(P=0.588), respectively. The patients with international prognostic index (IPI) score of 0, 1, and>1 achieved PFS of 85.4%, 74.4%, and 55.6%(P=0.011), respectively. The PFS rates were 81.2%and 66.1%(P=0.018) for stagesⅠandⅡ, respectively, and 86.6%and 63.3%(P=0.006) for the normal and elevated LDH levels, respectively. The pathological type of pure DLBCL or a MALT component, GCB or non-GCB origin, and age more than 60 years old were not associated with prognosis. Conclusion:The majority of the PGLBCL patients were in the early stage of disease, but the outcome of early-stage disease was favorable. Surgery did not improve outcomes. Univariate analysis demonstrated that IPI score>1, stageⅡdisease, and elevated LDH levels were associated with poor prognosis in the early-stage patient.

The differential diagnostic value of 18 F-DG PET/CT imaging on gastric malignancies / 重庆医学

Objective To investigate the differential diagnostic value of 18 F‐DG PET/CT imaging on gastric malignancies and primary gastric lymphoma(PGL) .Methods A total of 93 cases of gastric cancer (23 cases of mucinous adenocarcinoma and 70 ca‐ses of non mucinous adenocarcinoma ) ,58 cases of PGL and 31 cases of Diffuse Large b Cell Lymphoma (DLBCL ) and 27 cases of Mucosa associated tissue lymphoma (MALT) treated in our hospital from Jun 2012 to Jun 2015 were involved in this study .Their clinical data ,SUVmax ,maximum lesions thickness ,CT value ,lesion shape ,merge splenomegaly and lymph node metastasis were compared .The relation between SUVmax and maximum lesions thickness were analyzed with Pearson analysis .Results The aver‐age age and the lesions involve cardiac orifice rate of the gastric cancer group were significantly higher than that of PGL group (P0 .05) .Conclusion The diagnostic value of 18 F‐FDG PET/CT in gastric malignancies was high ,and patients with different cancer and pathological type were different in SUVmax ,maximum le‐sions thickness and lesion shape .

A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma / 대한소화기학회지

In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.

Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy

It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.

Treatment and prognosis of primary gastric lymphoma / 中华消化外科杂志

Objective To investigate the treatment methods for primary gastric lymphoma (PGL) and analyze the prognostic factors.Methods The clinical data of 55 patients with PGL who were admitted to the First Affiliated Hospital of Dalian Medical University from July 2002 to December 2007 were retrospectively analyzed.Operation,medication or operation combined with medication were applied to patients according to the pathological type,clinical staging,infection of helicobacter pylori and complications.Patients were followed up via phone call till February 2013,and the location,diameter,pathological type,clinical stage of the PGL and the treatment methods were recorded for prognostic analysis.The survival rate was calculated by Kaplan-Meier method,and the univariate analysis of survival was done by Log-rank test.Multivariate analysis was done by COX regression model.Results The PGL located at the gastric antrum in 26 cases,body of the stomach in 17 cases,fundus of the stomach in 5 cases,gastric cardia in 3 cases,body and antrum of the stomach in 4 cases.There were 46 patients with ulcerous PGL,5 with nodular PGL and 4 with diffused and infiltrated PGL.There were 53 B cell lympboma,1 T cell lymphoma and 1 undefined tumor.Of the 53 patients with B cell lymphoma,36 were with mucosa-associated lymphoid tissue lymphoma (MALTL) and 17 with diffuse large B-cell lymphoma (DLBCL).There were 23 patients in stage Ⅰ,23 in stage Ⅱ,4 in stage Ⅲ and 3 in stage Ⅳ.Of the 55 patients,23 received operation,14 received medication,17 received operation + medication,and 1 left untreated.Fifty-three patients had complete follow-up data.The median time of follow-up was 60 months (range,7-132 months).The 1-,3-,5-year cumulative survival rates were 91％,79％ and 72％.The results of univariate analysis showed that tumor diameter,pathological type and clinical staging were risk factors influencing the prognosis of PGL patients (x2 =9.34,6.59,88.01,P ＜ 0.05),while the treatment methods did not influence the prognosis of PGL patients (x2 =3.63,P ＞ 0.05).The results of multivariate analysis showed that DLBCL,clinical stages Ⅲ and Ⅳ were independent risk factors influencing the prognosis of PGL patients (OR =5.758,2.231,95％ confidence interval:2.536-13.073,1.370-3.625,P ＜ 0.05).Conclusion Multi-disciplinary team treatment should be recommended for PGL patients.Pathological type (DLBCL) and clinical stages (stage Ⅲ and Ⅳ) are the independent risk factors influencing the prognosis of PGL patients.

Tejido linfoide y linfomas gástricos / Lymphoid tissue and gastric lymphomas

En este artículo hemos realizado una amplia revisión de los linfomas primarios gástricos, su clasificación y aspectos clínico-patológicos más importantes, haciendo énfasis especial en los linfomas MALT o asociados a las mucosas y su relación con la infección por Helicobacter pylori.

In this review we describe various aspects of the primary gastric lymphomas, the classification, and the most important clinico-pathological aspects, with emphasis in mucosa associated lymphoma (MALT) and the Helicobacter pylori infection.

A Case of Primary Peripheral T-cell Lymphoma of the Stomach with Cytotoxic Phenotype / 대한소화기내시경학회지

Primary gastric lymphoma is the most common form of extralymphatic non-Hodgkin's lymphoma (NHL). Most cases are of B-cell origin and few cases of lymphoma of T-cell origin have been reported. Peripheral T cell lymphoma is a lymphoma of extrathymic origin. Expression of T-cell intracellular antigen (TIA)-1 can be detected in all cytotoxic cells, and the expression of this cytotoxic protein is associated with extranodal presentation. We report a case of primary peripheral T cell lymphoma of the stomach with cytotoxic T-cell phenotype in a 70-year-old male presenting with upper gastrointestinal bleeding.

Primary Gastrointestinal Lymphoma: A Comparison of Survival Rates between Gastric and Intestinal Non-Hodgkin's Lymphoma / 대한암학회지

PURPOSE: The purpose of this study was to evaluate the differences in survival rates between primary gastric and intestinal gastrointestinal non-Hodgkin's lymphoma (NHL) and to investigate risk factors for survival. MATERIALS AND METHODS: We reviewed survival rates and risk factors in 60 cases with stage I and II primary gastrointestinal lymphomas treated at Keimyung University Hospital between January 1972 and August 1999. RESULTS: No differences in sex, age, histology, stage, or percentage of curative resection were observed between primary gastric and intestinal lymphoma. The overall 10-year survival rates of gastric and intestinal NHL were 68.1% and 39.6%, respectively (p<0.05). The overall 10-year survival rates in stage I gastric and intestinal NHL were 66.7% and 70.0%, respectively, while those in stageII were 65.1% and 23.7%, respectively (p<0.001). A multivariate analysis of risk factors for survival revealed that the site of origin (5.68, CI=1.8-17.5) and stage (4.22, CI= 1.19-14.85) were significantly correlated with prognosis (p<0.05). There was no significant difference in the expression of bcl-2 and p53 between gastric and intestinal NHL. Furthermore bcl-2 and p53 expressions were not correlated with the prognosis. CONCLUSION: This study indicates that stage II primary intestinal lymphoma has lower survival rate than gastric lymphoma.

A case of Burkitt's lymphoma cell leukemia in primary gastric lymphoma / 대한내과학회지

Burkitt's lymphoma is a distinct clinical entity classified as an undifferentiated lymphoma of B-lymphocytic origin. Burkitt's lymphoma cell leukemia occurs when Burkitt's lymphoma cells represent more than 20% of marrow cells and exceed about 5000/ul in blood. We report a case of Burkitt's lymphoma cell leukemia in primary gastric lymphoma in 55-year-old man with 5kg of weight loss for 2 months and epigastric pain for 3 days. Primary gastric lymphoma was diagnosed by biopsies with gastrofiberoscopy and upper abdominal CT scan in this patient. During admission, peripheral blood smear revealed sudden increase in abnormal blasts with multiple vacuoles. Burkitt's lymphoma cell leukemia was diagnosed by peripheral blood smear, bone marrow aspiration and biopsy, immunophenotyping and cytogenetic analysis in this patient. For its great rarity, we report this case with review of literature.

Clinical Analysis of Surgically Treated Primary Gastric Lymphoma / 대한암학회지

PURPOSE: The incidence of primary gastric lymphoma is a relatively rare and is 2~5% of all gastric malignant lesion. Because of its rarity, there are few report in Korea. Therefore, to elucidste the clinicopathological characteristics and prognosis of primary gastric lymphoma and to investigate MALT(Mucosa-associated lymphoid tissue) lymphoma, we studied in primary gastric lymphoma. MATERIALS & METHODS: we evaluated retrospectively primary gastric lymphoma patients who underwent gastric resection from Jan. 1990 to Dec. 1994 in KCCH. RESULTS: There were 20 patients with primary gastric lymphoma and the incidence is 0.54% of all gastric malignant lesion. Abdominal pain, primarily epigastric, was the most common presenting complaint and the most common location was the distal third of the stomach. The overall 5-year survival rate was 71%. Factor significantly influencing 5-year survival rate was the serosal invasion. Age, gender, tumor size, histologic grade, nodal status and Ann-Arbor staging system did not influence survival. CONCLUSION: So,we suggest that the depth of invasion should be included in staging system of gastric lymphoma because Ann Arbor staging system might be inadequate when applied to primary gastric lymphoma. Also, we suggest that the multicenter study should be performed to elucidate the characteristics of Korean gastric lymphoma because of its low incidence.

Prognostic Factors of Primary Gastric Lymphoma

BACKGROUND/AIM:Primary gastric lymphoma is uncommon, but the incidence of this malignancy is increasing. The purpose of this review was to find prognostic factors and establish an effective treatment principle for primary gastric lymphoma. METHODS: Between 1989 and 1996, 61 patients with primary gastric lymphoma were treated at the Asan Medical Center. Retrospective analysis and a pathologic review of these cases was performed. RESULTS: The mean age was 50 years (range:16~81 years). There were 26 men and 35 women. The stages, according to the Ann Arbor staging system, were Stage IE ,IIE in 72.1% of the patients and stage IIIE, VIE in 27.9% of the patients. Forty (40) patients received operations:38 surgical resections, 1 biopsy, and 1 bypass surgery. Forty-six (46) patients received chemotherpy, and among them, 26 received chemotherapy after surgical resection. The 5-year survival rate was 100% in stage IE, IIE and 51% in stage IIIE, IVE. The mean follow- up period was 25.6 months. CONCLUSION:Statistically significant prognostic factors were tumor stage and surgical resection.

Endoscopic Diagnosis of Primary Gastric Lymyhoma / 대한소화기내시경학회지

Primary gastric lymphorna represents one to 7% of all gastric cancer and is the most common type of extranodal lymphoma. In attempt to evaluate the endoscopic characteristics, we analysed clinical and endoscopic findings in 35 patients with primary gastric lymphoma between January 1980 and August 1994 at the Yonsei Medical Center. The results were as follows: 1) The mean age of patients was 47.1 years with male to female ratio of 1.5: l. 2) Gastroscopy was performed in all 35 patienits, which revealed polypoid lesion in one case(2.9%), ulcerative lesion in 15 cases(42.9%), ulcero-infiltrative lesion in 6 cases(17.1%) and diffuse infiltrative lesion in 2 cases(5.7%). Gastric lymphoma was suggested in 6 cases, advanced gastric cancer in 21 cases, early gastric cancer in 5 cases and benign gastric ulcer in 3 cases. Pathologic diagnosis of biopsy specimens were gastric lymphoma in 24 cases, adenocarcinoma in 5 cases and chronic superficial gastritis in one case. 3) The characteristics of the endoscopic findings in gastric lymphoma were intractable or recurrent ulcer in 10 cases, thickened and mounded ulcer margin in 9 cases, multiple ulcers in 9 cases, giant rugae in 7 cases and polypoid or depressed lesion with central ulceration in 4 cases. In conclusion, recognition of specific endoscopic findings such as intractable or recurrent ulcer, volcano-like ulcer, multiple ulcers, giant rugae and combined lesion, the possibility of a lymphoma should be considered and vigorous biopsy attempts should be carried out. Then if the first microscopic report does not suggest this diagnosis, a second investigation including jumbo biopsies, perhaps by diathermy, should be undertaken.

Primary malignant lymphomas of the stomach. Pathological and clinical analyses of 38 resected cases

The stomach is the most frequent site of extranodal lymphoma and primary gastric lymphoma might be distinguished from the nodal lymphoma by its different pathogenesis and prognosis. Based on the Isaacson's classification, clinico-pathologic reviews of 38 resected primary gastric lymphomas were done. Immunohistochemical stainings for PCNA, B and T cell markers, bcl-2 and p53 were performed. Eighteen were of low grade and 20 were of high grade. There were significant differences between low and high graders in the aspect of the size, depth of lesion, gross type, immunophenotype, staining intensity for PCNA, expressions of bcl-2 and p53. The overall 2-year survival rate was 85.3%. Factors with prognostic significance on survival by univariate analyses included immunophenotype, histologic grading and PCNA staining pattern. After multivariate analyses, immunophenotype proved to be a significant factor. We think that the histologic grading by Isaacson's classification and the immunohistochemical stainings performed were useful in pathologic and/or clinical aspects. The excellent survival rate in this study was partly due to the selection of resectable cases. However, earlier diagnosis and appropriate treatment might have contributed to the improved prognosis of gastric lymphoma in recent years.

Primary malignant lymphomas of the stomach. Pathological and clinical analyses of 38 resected cases

The stomach is the most frequent site of extranodal lymphoma and primary gastric lymphoma might be distinguished from the nodal lymphoma by its different pathogenesis and prognosis. Based on the Isaacson's classification, clinico-pathologic reviews of 38 resected primary gastric lymphomas were done. Immunohistochemical stainings for PCNA, B and T cell markers, bcl-2 and p53 were performed. Eighteen were of low grade and 20 were of high grade. There were significant differences between low and high graders in the aspect of the size, depth of lesion, gross type, immunophenotype, staining intensity for PCNA, expressions of bcl-2 and p53. The overall 2-year survival rate was 85.3%. Factors with prognostic significance on survival by univariate analyses included immunophenotype, histologic grading and PCNA staining pattern. After multivariate analyses, immunophenotype proved to be a significant factor. We think that the histologic grading by Isaacson's classification and the immunohistochemical stainings performed were useful in pathologic and/or clinical aspects. The excellent survival rate in this study was partly due to the selection of resectable cases. However, earlier diagnosis and appropriate treatment might have contributed to the improved prognosis of gastric lymphoma in recent years.