Clinical, endoscopic, pathologic and prognostic factors of primary gastric lymphoma / 中华消化杂志

Objective To explore the clinical,endoscopic,pathologic and prognostic characteristics of primary gastric lymphoma (PGL) and to improve the level of diagnosis and treatment.Methods Sixtythree patients who were confirmed as PGL with operation and endoscopic biopsy pathology during January 2001 to December 2010 were retrospectively analyzed with respects of clinical,endoscopic and pathologic features.Survival analysis and prognosis were evaluated by kaplan-Meier and Cox proportional hazard model,respectively.Results In 63 PGL patients,the numbers of male and female were 40 and 23,respectively,and the average age was (59.8±13.3)years.The major symptoms were abdominal pain,abdominal distension,and gastrointestinal hemorrhage,accounting for 47.6 ％ (30/63),17.5 ％ (11/63),and 17.5 ％ (11/63),respectively.There were 39 (61.9 ％) PGL patients with endoscopic performance for ulcers,34 (54.0 ％) cases involved the gastric stomach antrum.The most immunohistochemistry analyses were diffuse large B-cell lymphoma (DLBCL) (71.4 ％,45/63),followed by mucosa-associated lymphoid tissue (MALT) lymphoma (22.2％,14/63).The frequency of Helicobacter pylori (H.pylori) positivity was lower in patients with DLBCL than that in patients with MALT lymphoma (37.8％(17/45) vs 10/14,x2 =4.872,P=0.027).The accumulate survival rates of one,three and five years were 74.6％,63.5％,55.6％,respectively,and the average survival time was (41.5±3.0) months (95％ confidence interval (CI) 35.7 to 47.4 months) in PGL patients.There was no difference in the average survival time between DLBCL patients treated with surgery combined chemotherapy and those with surgery or chemotherapy alone (38.33±5.21) months vs (50.17±8.98) months vs (41.39±4.40) months,P＞0.05).The patients diagnosed as DLBCL with H.pylori positive had longer average survival time than those with H.pylori negative ((51.90±4.30) months vs (33.30±4.50) months,t=-4.004,P＜0.01).Conclusions Male patients with PGL are slightly more than female.Abdominal pain is the most frequent symptom.Ulcerative lesions are the most common endoscopic demonstrations mostly at stomach sinus.DLBCL is the most pathologic characteristic.There is no significant difference in the survival rate between patients treated with surgery combined with chemotherapy and those treated with surgery or chemotherapy alone.

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.

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.

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.

Value of 18F-FDG PET/CT examination in the differential diagnosis of gastric cancer and primary gastric lymphoma / 中华消化外科杂志

Objective To explore the value of 18 F-fluorodeoxyglucose (i8 F-FDG) PET/CT examination in the differential diagnosis of the gastric cancer and primary gastric lymphoma (PGL).Methods The clinical data of 80 patients with gastric cancer (60 with non-mucinous adenocarcinoma and 20 with mucinous adenocarcinoma) and 47 patients with PGL [22 with mucosa-associated lymphoid tissue (MALT) and 25 with diffuse large B-cell lymphoma (DLBCL)] who were admitted to the Tianjin Medical University Cancer Institute and Hospital from June 2006 to May 2014 were retrospectively analyzed.Spiral CT scan was first done and then followed by PET.The CT value of the lesions,maximum standardized uptake value (SUVmax) of patients and maximal gastrointestinal wall thickness (THKmax) were analyzed by the ANOVA test.The SUVmax comparison between groups was evaluated with the Student-Newman-Keuls.The lesions type was analyzed by the chi-square test.The THKmax and SUVmax among groups were analyzed by the Pearson correlation analysis.Results 18 F-FDG PET/CT imaging of patients with gastric cancer and PGL showed different types of gastric wall thickening,segmental and limited thickening of gastric wall were the main features of gastric cancer and diffuse and segmental thickening of gastric wall were the main features of PGL.The type Ⅰ,Ⅱ and Ⅲ of lesions were detected in 12,21 and 27 of 60 patients with nonmucinous adenocarcinoma,in 2,7 and 11 of 20 patients with mucinous adenocarcinoma,in 8,8 and 6 of 22 patients with MALT and in 13,7 and 5 of 25 patients with DLBCL respectively.There were significant differences in the 4 pathological types of lesions among all the patients (x2 =14.849,P ＜ 0.05).The lymph nodes beneath the renal hilum and at the retroperitoneum were involved in 16 patients with gastric cancer and in 10 patients with PGL,and 7 patients with gastric cancer and 12 patients with PGL were complicated with splenomegalia,respectively,showing a significant difference in the splenomegalia between patients with PGL and gastric cancer (x2=7.506,P ＜0.05).There was no significant difference in the metastasis of lymph nodes beneath the renal hilum and at the retroperitoneum between patients with PGL and gastric cancer (x2=0.178,P ＞0.05).Among 80 patients with gastric cancer,positive 18F-FDG was detected in 79 patients and negative 18F-FDG in 1 patient with T3 stage of mucinous adenocarcinoma.Among 47 patients with PGL,positive 18 F-FDG was detected in 46 patients and negative 18F-FDG in 1 patient with stage Ⅰ of MALT.The CT value of the lesion,SUVmax and THKmax in patients with non-mucinous adenocarcinoma,mucinous adenocarcinoma,MALT and DLBCL were (40 ± 8)HU,(39±11)HU,(41±11)HU,(38±9)HU and 9.9 ±6.6,5.6±1.9,4.6 ±2.9,18.3±7.6 and (2.1 ± 1.2) cm,(1.9 ± 0.9) cm,(1.3 ± 1.1) cm and (2.6 ± 1.5) cm,respectively,showing significant differences in the SUVmax among all the groups (F =26.920,P ＜ 0.05).In the pairwise comparisons,there were no significant difference between the MALT group and mucinous adenocarcinoma group (P ＞ 0.05),and significant differences among the other groups (P ＜ 0.05).The CT value of the lesions and THKmax among all the patients were compared,with no significant differences (F =0.578,4.510,P ＞ 0.05).There were no significant differences in the SUVmax and THKmax among all the patients (r =0.055,0.346,0.226,0.133,P ＞ 0.05).Conclusions There is an important diagnosis value of PET/CT examination in patients with gastric cancer and PGL.The pathological types of the lesions in patients with gastric cancer and PGL are different.The occurrence of splenomegalia in patients with PGL is easier than that with gastric cancer.SUVmax of patients with DLBCL is higher than those with gastric cancer and MALT.FDG uptake in patients with mucinous adenocarcinoma and MALT are not enough,and these may lead to false negative result of PET/CT examination.

Diagnostic value of MSCT in stomach common malignant tumor / 中国医学装备

Objective:To retrospectively analyze the CT features among gastric cancer, gastric lymphoma and gastric malignant stromal tumors, evaluated the application value of MDCT in gastric malignant tumor.Methods: Sixty two patients with gastric malignancies tumor confirmed by pathology underwent MDCT plain scanning and triphasic contrasted scanning before operation. Referring to the pathological results, to observe the CT signs, include: scope of tumors and involvement, the density of tumors and enhanced characteristics, mucosal membrane, the change of the stomach softness, peripheral lymph node enlargement, the involvement of other organs, and to make statistical analysis for imaging features of these tumors byx2 testing.Results: Sixty two cases of gastric malignant tumor included 42 cases of gastric carcinoma, 12 cases of gastric lymphoma and 8 cases of gastric malignant stromal tumor, were confirmed by postoperative pathology. The CT manifestations were as follows: the stomach mucous membrane surface involvement in all the gastric cancer, the positive rate was significantly higher than gastric lymphoma and stromal tumor. The area involved by lymphoma were more than two partitions, significantly higher than that of gastric cancer and stromal tumor (x2=36.643,x2=20.00;P<0.05). 39 cases (92.8%) of gastric cancer and 8 cases (100%) of malignant stromal tumors were significantly enhanced, but all gastric lymphoma were not obvious enhancement. The positive rate of enlarged lymph nodes in gastric cancer(61.9%) and lymphoma(83.3%) were higher than stromal tumor(12.5%)(x2=9.731,x2=6.603;P<0.05).Conclusion: The CT manifestations of the gastric cancer, lymphoma, malignant stromal tumors had different characteristics. Multislice CT for the diagnosis and differential diagnosis of gastric malignant tumor has important value.

Gastric Perforation Caused by Primary Gastric Diffuse Large B Cell Lymphoma / 대한소화기학회지

Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.

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.

Gastric Burkitt Lymphoma in a Six Year-old Boy Presenting with Upper Gastrointestinal Bleeding / 임상소아혈액종양

Childhood Burkitt lymphoma is most often diagnosed in the abdomen, with the majority of intra-abdominal cases arising from the small or large intestines. Involvement of the gastric mucosa is rare. Here, we present a six-year-old boy who was found to have gastric Burkitt lymphoma through biopsy obtained by esophagogastroduodenoscopy. The child was treated with six cycles of chemotherapy without surgery, and he remains free of disease fourteen months since initial diagnosis. Early definitive diagnosis through endoscopic biopsy and appropriate treatment are necessary for rare instances where children present with upper gastrointestinal tract tumors.

Gastric Burkitt Lymphoma in a Six Year-old Boy Presenting with Upper Gastrointestinal Bleeding / 임상소아혈액종양

Childhood Burkitt lymphoma is most often diagnosed in the abdomen, with the majority of intra-abdominal cases arising from the small or large intestines. Involvement of the gastric mucosa is rare. Here, we present a six-year-old boy who was found to have gastric Burkitt lymphoma through biopsy obtained by esophagogastroduodenoscopy. The child was treated with six cycles of chemotherapy without surgery, and he remains free of disease fourteen months since initial diagnosis. Early definitive diagnosis through endoscopic biopsy and appropriate treatment are necessary for rare instances where children present with upper gastrointestinal tract tumors.

Gastric Burkitt Lymphoma in a Six Year-old Boy Presenting with Upper Gastrointestinal Bleeding / 임상소아혈액종양

Childhood Burkitt lymphoma is most often diagnosed in the abdomen, with the majority of intra-abdominal cases arising from the small or large intestines. Involvement of the gastric mucosa is rare. Here, we present a six-year-old boy who was found to have gastric Burkitt lymphoma through biopsy obtained by esophagogastroduodenoscopy. The child was treated with six cycles of chemotherapy without surgery, and he remains free of disease fourteen months since initial diagnosis. Early definitive diagnosis through endoscopic biopsy and appropriate treatment are necessary for rare instances where children present with upper gastrointestinal tract tumors.

Neoplasias gástricas / Gastric neoplasias

El tumor carcinoide y el linfoma gástrico constituyen del 2 al 5 por ciento del total de las neoplasias gástricas. El objetivo de este trabajo consistió en presentar 5 pacientes con sus características clínicas, hallazgos macroscópicos e histológicos de estas variedades de tumor gástrico, poco frecuentes a escala mundial. Tres de estos pacientes se les diagnosticó tumor carcinoide, a uno de ellos, con lesión única se le efectuó resección endoscópica, a los dos restantes, cuya lesión macroscópica era múltiple, se les indicó tratamiento quirúrgico convencional. Histológicamente el linfoma MALT se clasificó de bajo grado de malignidad, asociado a células B; los 2 pacientes diagnosticados con dicha afección recibieron quimioterapia y se les trató el Helicobacter pylori. El diagnóstico y tratamiento adecuado y oportuno de los pacientes con estas entidades enriquece los conocimientos acerca del tema, además de garantizar la supervivencia así como una mejor calidad de vida

The carcinoid tumor and the gastric lymphoma accounted for the 2-5 percent of total of gastric neoplasias. The objective of present paper is to present the case of 5 patients with clinical characteristic, macroscopic and histological findings of these varieties of gastric tumor, but no much frequent at world scale. Three of these patients were diagnosed with carcinoid tumor and one of them with a unique lesion underwent endoscopic resection; the remainder two whose macroscopic lesion was multiple, it was prescribed a conventional surgical treatment. Histologically, the MALT lymphoma was classified of low degree of malignancy associated with B cells; the two patients diagnosed with such affection receiver chemotherapy with treatment for Helicobacter pylori. An appropriate and timely diagnosis and treatment of patients presenting with these entities increase the knowledges on this subject, also to guarantee its survival as well as a better quality of life

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.

The enigma of Helicobacter pylori infection and gastric cancer.

Abstract Although H. pylori has been recognized as a class I carcinogen, incongruence between infection prevalence and cancer incidence has been reported. Holcombe called attention to the high prevalence of infection in the face of low cancer rates, which he called “The African Enigma”. Similar observations have now been made in other geographic areas. Gastric carcinoma should be considered an infectious disease, for which the classical epidemiologic model of causality applies. The model proposes that tissue injury inflicted by the infectious agent is modulated by its interactions with host and environmental factors. Although approximately half of the world’s population is infected, only a small proportion of people develop cancer. The African enigma is a striking example of the major contrasts in cancer risk among populations with similarly high prevalence of infection. The mechanisms involved in reducing the risk of cancer in infected individuals are explored in this article, which may lead to the design of effective prevention strategies.

Gastrointestinal Lymphoma / 대한소화기내시경학회지

Gastrointestinal lymphoma is the leading cause of extranodal lymphoma. Gastric lymphoma is very common in patients with gastrointestinal lymphoma, and diffuse large B-cell lymphoma and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) are the most common histological types. Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of MALT lymphoma, and eradication of H. pylori has successfully resulted in the remission of MALT lymphoma. In the cases of H. pylori-negative MALT lymphoma or advanced gastric lymphoma, radiation therapy and/or chemotherapy can be used to treat the disease and achieve remission.

Therapeutic Comparison of Chemotherapy and Surgery for Early Stage Diffuse Large B-cell Gastric Lymphoma

PURPOSE: The use of surgery versus stomach-preserving treatment for primary gastric lymphoma has caused controversy among doctors. This retrospective, single center study aims to evaluate the efficacy and benefit of stomach-preserving treatment against surgery for early stage diffuse large B-cell lymphoma of stomach. MATERIALS AND METHODS: From August 1991 to January 2006, 43 cases of early-stage diffuse large B-cell gastric lymphoma were reviewed. RESULTS: Eleven cases were treated with chemotherapy or chemotherapy plus radiation (CT +/- RT), 17 were treated with surgery alone (OP), and 15 were treated with surgery plus adjuvant chemotherapy (OP + CT). The complete remission and response rates were 63.6% and 90.9% in those treated with CT +/- RT (7 complete responders, 3 partial responders, 1 non-responder), 100% and 100% in those treated with OP, and 100% and 100% in those treated with OP + CT, respectively. Five-year overall survival rates were 85.7%, 87.5%, and 100% in those treated by CT +/- RT, OP, and OP + CT, respectively (p=0.76). The five-year disease free survival rates were 100%, 87.5% and 100% in those treated by CT +/- RT, OP, and OP + CT, respectively (p=0.99). There was no significant difference in overall survival and disease free survival between modalities. Even though there are no definite differences in the number of complications between those treated by CT +/- RT or OP, these facts reflect little concern on complications after surgery. CONCLUSION: In preventing morbidity arising from early or late complications from surgery and promoting quality of life, chemotherapy should be a primary consideration for early stage diffuse large B-cell lymphoma of the stomach.

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.