Malignant lymphomas of the upper gastrointestinal tract. Results of a prospective study in 103 patients

Fischbach, Wolfgang; Kestel, W; Kirchner, Thomas; Mössner, Joachim; Wilms, K.

doi:10.1002/1097-0142(19920901)70:5<1075::aid-cncr2820700511>3.0.co;2-1

Cited by 66 publications

(19 citation statements)

References 27 publications

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“…The involvement of the gastrointestinal tract by lymphoma may be primary [5][6][7] or secondary due to disseminated nodal disease. [8][9][10][11] Because of the unique properties of the gastrointestinal system, Issacson and Wright, 12 in 1983, introduced the term MALT; thereby classifying primary gastrointestinal lymphoma as a distinct entity with unique histological and biological features. [12][13][14] Overall, primary gastric lymphomas are rare and represent only 1%-5% of all malignant disorders of the stomach.…”

Section: Discussionmentioning

confidence: 99%

Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers

Misra

Dwivedi

2005

Postgraduate Medical Journal

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Primary gastric lymphoma is a rare tumour. It is thought that low grade gastric mucosa associated lymphoid tissue lymphoma has not been previously reported to occur in a patient with gastrojejunostomy. This report describes such a case. The patient presented with bleeding from non-healing stomal ulcers. The ulcers healed and there was regression of the tumour after eradication of Helicobacter pylori. P rimary gastric lymphoma (PGL) is a rare tumour of the stomach and accounts for only 1%-5% of all malignancies of the stomach.1 PGL may be low grade gastric mucosa associated lymphoid tumours (commonly called MALToma) or high grade B cell tumours.2 There are three main endoscopic appearances of PGL.3 4 The lesion can be tumour-like with polypoid mass, it can be ulcerative type with erosions and ulceration, or it can be hypertrophic type with large, nodular, and giant folds.3 4 We describe a patient with MALToma at the site of gastrojejunostomy, presenting as upper gastrointestinal (UGI) bleeding from stomal ulcers. Endoscopic biopsy specimens showed gastric MALT lymphoma and eradication of Helicobacter pylori led to healing of the stomal ulcers and regression of MALT lymphoma. We believe this is the first report of its kind. CASE REPORTA 50 year old man was admitted with history of melena for the past three days. He had had a similar episode of melena three months previously that lasted five days and resolved on conservative treatment. Three units of blood were transfused. Endoscopy was not performed. He had type II diabetes mellitus that was well controlled with oral hypoglycaemic drugs. He was also receiving oral pantoprazole 40 mg per day. Elective gastrojejunostomy and truncal vagotomy were performed for peptic ulcer in 1974. Between 1974 and to date he was asymptomatic and was not taking any medication. The patient denied consuming anti-inflammatory drugs and was very particular about his medication. He was a vegetarian and a teetotaller. Clinically, he was pale. There was no icterus, clubbing, cyanosis, or lymphadenopathy. Haemoglobin was 78 g/l, total and differential leucocyte counts were within normal limits. Peripheral blood film showed hypochromia and microcytosis. Fasting and postparandial blood glucose, serum bilirubin, aminotransferases, amylase, urea, blood urea, prothrombin time, INR, and platelet count were within normal limits. UGI endoscopy was performed. The gastrojejunostomy site showed severe ulceration with necrotic areas. There was oozing of blood from the ulcers. A few nodular lesions were also seen on and around the gastrojejunostomy stoma (fig 1). Both the afferent and the efferent loops were normal. The pylorus and duodenum were also normal. Argon plasma coagulation of the bleeding lesions was performed and haemostasis achieved. Multiple biopsy specimens were obtained from the margin and the surrounding area of the gastrojejunostomy stoma, the nodular lesions, and from the antrum of the stomach. One antral biopsy specimen was used for the rapid urease test and several other pieces were s...

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Section: Discussionmentioning

confidence: 99%

Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers

Misra

Dwivedi

2005

Postgraduate Medical Journal

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“…Nodale NHL können im Rahmen der Krankheitsdissemination auch den Gastrointestinaltrakt befallen. Bei systematischen Untersuchungen wurden solche sekundären gastrointestinalen Lymphome in einer Häufigkeit von etwa 20 % beobachtet [1]. Hiervon abzugrenzen sind die primären gastrointestinalen Lymphome, die im Magen-Darm-Trakt entstehen, aber abhängig vom histologischen Typ mehr oder weniger häufig ebenfalls in Lymphknoten oder andere Organe disseminieren können.…”

Section: Hintergrund Und Klassifikationunclassified

Intestinale Lymphome

Fischbach

2015

Gastroenterologe

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Die malignen Lymphome werden in die Gruppe der Hodgkin-Lymphome (Morbus Hodgkin) und der Non-HodgkinLymphome (NHL) unterteilt (. Abb. 1). Unter letzteren sind etwa 60 % nodalen und 40 % extranodalen Ursprungs (nodale bzw. extranodale NHL). Nodale NHL können im Rahmen der Krankheitsdissemination auch den Gastrointestinaltrakt befallen. Bei systematischen Untersuchungen wurden solche sekundären gastrointestinalen Lymphome in einer Häufigkeit von etwa 20 % beobachtet [1]. Hiervon abzugrenzen sind die primären gastrointestinalen Lymphome, die im Magen-Darm-Trakt entstehen, aber abhängig vom histologischen Typ mehr oder weniger häufig ebenfalls in Lymphknoten oder andere Organe disseminieren können. Sie stellen innerhalb der extranodalen Lymphome mit etwa 50 % die bei weitem größte Gruppe dar.. Tab. 1 zeigt die WHO-Klassifikation der primären gastrointestinalen Lymphome [2]. Unter den Magenlymphomen dominieren zahlenmäßig klar (> 95 %) die Marginalzonen-B-ZellLymphome des "mucosa-associatedlymphoid tissue" (MALT) und die diffusen großzelligen B-Zell-Lymphome (DGBZL) mit oder ohne MALT-Komponente. Die Besonderheit der intestinalen Lymphome ist, dass hier neben den verschiedenen B-Zell-Lymphomen auch das enteropathieassoziierte T-ZellLymphom (EATZL) in Erscheinung tritt.Die verschiedenen Lymphomsubtypen können durch histologische, immunhistochemische und molekulargenetische Charakteristiken klassifiziert werden. In Einzelfällen ist ein Rückgriff auf das Disseminationsmuster erforderlich, um den primär gastrointestinalen Ursprung des Lymphoms zu identifizieren.

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“…MALT lymphoma accounts for 7-8% of all B-cell lymphomas and at least 50% of primary gastric lymphomas, with the highest incidence between 50 and 60 years of age (1). …”

Section: Introductionmentioning

confidence: 99%

An Aggressive Form of MALT Lymphoma of the Stomach with Pancreas Infiltration

Mulalic

Delibegović

2016

Med Arh

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Introduction:MALT lymphoma accounts for 7-8% of all B-cell lymphomas and at least 50% of primary gastric lymphoma, with the highest incidence at between 50 and 60 years of age. Aggressive forms are rare, as are indications for multi-visceral resection.Case study:A patient, 33 years old, was admitted to the tertiary hospital due to a biopsy at a small community hospital confirming adenocarcinoma of the stomach. She was Helicobacter pylori positive. CT showed thickening of the fundus and corpus wall, up to 2.7. cm., with numerous lymph nodes, along the small curvature and in the peripancreatic region, up to 1.5 cm in size. There was close contact between the changed and tumorous posterior wall of the stomach and the anterior surface of the pancreas. Neoplasm of the stomach was found that had infiltrated the body and tail of the pancreas and spleen hilum. Infiltration of the left crura of the diaphragm was also found, ex tempore biopsy showed inflammatory infiltration without elements of neoplasm. Total gastrectomy with omentectomy, and subtotal pancreatectomy and splenectomy were performed. Definitive patho-histological diagnosis confirmed MALT lymphoma of the stomach with pancreas infiltration, but no tumor cells were found on the spleen. Additional staining and immunohistological examination of the specimen from the community hospital showed that this was a misdiagnosis of carcinoma, and the specimen also contained MALT lymphoma.Discussion:MALT lymphoma frequently occurs in the stomach. For patients with MALT, systematic staging is indicated. If MALT is considered in the differential diagnosis, multiple random systematic biopsies within the stomach wall are needed to optimize diagnostic accuracy. Samples should be subject to immune phenotype analysis6. The main tumor cells of MALT are: CD 20+, CD 5-, CD 10-, CD 23-, CD 43+-. It is obvious that this kind of analysis cannot be accomplished in a small community hospital in a poor country such as Bosnia and Herzegovina, and suspicion of MALT indicates referral to a tertiary center. Although the long term risk of transformation of MALT lymphoma into the aggressive form is low9, this case of the aggressive form of MALT indicates the importance of systematic staging.

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Malignant lymphomas of the upper gastrointestinal tract. Results of a prospective study in 103 patients

Cited by 66 publications

References 27 publications

Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers

Low grade B cell gastric mucosa associated lymphoma presenting as upper gastrointestinal bleeding from non-healing stomal ulcers

Intestinale Lymphome

An Aggressive Form of MALT Lymphoma of the Stomach with Pancreas Infiltration

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