Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study

Abstract

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.

Intestinal T-cell lymphomas NOS presenting as a polypoidal lesion: A case report

“…Meanwhile, the initial complaints of these patients were typically related to gastrointestinal symptoms, including abdominal pain, nausea, vomiting, altered bowel habits, and even intestinal obstruction and perforation. [ 12 ] Gastrointestinal endoscopy can identify most abnormal mucosa in a relatively early stage. However, relevant studies about ITCL are rare due to low incidence and lack of endoscopic findings specificity.…”

“…However, relevant studies about ITCL are rare due to low incidence and lack of endoscopic findings specificity. The few existing studies have reported the most common endoscopic abnormalities in intestinal lymphoma are the ulcerated lesion followed by eminence lesion, in addition to the diffusely infiltratively lesion and lymphomatous polyposis lesion et al [ 12 – 14 ] Ulcerated lesions may present multiple or solitary, various in size, different in shades, irregular in shape, the edges are flat or irregularly thickened. Yet those performance is often misdiagnosed as inflammatory bowel disease.…”

A study on diagnosis and classification of gastrointestinal lymphoma based on histopathology and immunohistochemistry

“…Vì vậy không ngạc nhiên khi u lympho dạ dày -ruột là vị trí thường gặp nhất của u lympho ngoài hạch với tỉ lệ 30 -40% và là u ác tính thứ hai sau ung thư biểu mô tuyến khi tính ở dạ dày. Việc nhận định các tổn thương nghi ngờ u lympho dạ dày ruột trên nội soi được cho là có vai trò quan trọng nhằm tránh bỏ sót tổn thương và sinh thiết phù hợp [1]. Các nghiên cứu trước đây ở trong nước, đặc điểm mô học chủ yếu nhằm xếp loại theo công thức thực hành [2], [3].…”

“…Việc vận dụng đúng các đặc điểm này trong thực hành sẽ giảm được các chỉ định hóa mô miễn dịch không cần thiết. Tuy nhiên, các tổn thương này nằm ở mô đệm vì vậy đối với các mảnh bấm sinh thiết ở tổn thương nghi ngờ u lympho dạ dày ruột cần đảm bảo độ sâu [1].…”