The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma

Schizas, Dimitrios; Ntanasis‐Stathopoulos, Ioannis; Tsilimigras, Diamantis I.; Sioulas, Athanasios D.; Moris, Demetrios; Spartalis, Eleftherios; Scotiniotis, Ilias; Papanikolaou, Ioannis S.

doi:10.1155/2017/2397430

Cited by 15 publications

(9 citation statements)

References 41 publications

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“…pylori -associated T-cell lymphoma there are no guidelines for the endoscopic surveillance of patients following successful treatment of other gastric, small intestinal or colonic lymphomas. The role of endoscopic ultrasound in the follow-up of gastric lymphoma is yet to be defined 56. Nor are there guidelines for surveillance of at-risk individuals such as those with disorders associated with an increased risk for lymphoma, such as coeliac disease57 or nodular lymphoid hyperplasia 58 59…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal lymphoma: the new mimic

Thomas

Schwartz

Quigley

2019

BMJ Open Gastroenterol

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BackgroundGastrointestinal (GI) lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin lymphoma being extremely uncommon. The GI tract is the predominant site of extranodal non-Hodgkin lymphoma accounting for 30–40% of all extranodal lymphomas. In the Western world, the stomach is the most commonly involved site followed by the small bowel. Several chronic inflammatory and immune-mediated disorders which predispose to accelerated cell turnover may lead to the malignant transformation of gut lymphocytes and ultimately manifest as GI lymphoma. The challenge for the clinical gastroenterologist is that these tumors may have varied presentations, ranging from nonspecific symptoms such as dyspepsia or bloating to abdominal pain, nausea, vomiting, GI bleeding, diarrhea, weight loss or bowel obstruction.ObjectiveWe illustrate the range of presentations of GI lymphoma with examples based on consecutive cases evaluated at our institution over a 6-month period. These cases demonstrate how appropriately directed endoscopic evaluation with biopsies has the potential to provide a definitive diagnosis and allow the patient to proceed to definitive therapy.ConclusionsThe GI tract is the most commonly involved site for extranodal lymphoma with the stomach being most frequently involved organ.Chronic Helicobacter pylori infection, celiac disease, inflammatory bowel disease and autoimmune disorders may predispose to GI lymphoma. This heterogenous group of diseases has varied presentations that may mimic several other GI clinico-pathologic entities. GI lymphomas may be diagnosed with appropriately directed endoscopic evaluation coupled with generous tissue sampling and expert pathologic assessment. Management may range from antibiotic therapy, in the case of Helicobacter pylori-associated gastric MALT lymphoma, to chemotherapy with or without radiation and, in rare instances, surgery. There are presently no guidelines to direct endoscopic surveillance of GI lymphomas following treatment.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal lymphoma: the new mimic

Thomas

Schwartz

Quigley

2019

BMJ Open Gastroenterol

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“…Hypoechoic echogenicity and diffuse thickening with fusion of the echolayers are usually reported as the key EUS features for diagnosing lymphoma [19,20]. However, as these are not always apparent in EUS, an accurate diagnosis is difficult with EUS alone.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors

et al. 2019

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Background/AimsEndoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results. MethodsWe retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests. ResultsThe overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa. ConclusionsAPCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.

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“…A positron emission tomography (PET) scan is helpful as it can demonstrate an uptake in the stomach and the liver to express tumor activity but it won’t provide tissue diagnosis to differentiate synchronous versus metachronous tumor. Endoscopic ultrasound may play a role in early disease (stage I, II) [ 10 ]. The treatment of PGL includes chemotherapy, surgical resection, and some instances radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Aggressive primary gastric lymphoma (PGL) masquerading as hepatocellular cancer (HCC) in alcoholic cirrhosis

et al. 2021

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Background The gastrointestinal tract is sa well-known site for extranodal Non-Hodgkin lymphomas, with the stomach is known to be the most common site on lymphoma, primary gastric lymphoma (PGL). The lymphoproliferative disorder rarely occurs in patients with cirrhosis. We report a unique case of metastatic PGL in a patient with cirrhosis. Case presentation A middle-aged male with decompensated alcoholic cirrhosis presented with two weeks of epigastric abdominal pain, abdominal distension, and jaundice. Abdominal triple-phase CT scan was consistent with cirrhosis, ascites, and multiple new hypodense liver lesions classified as an intermediate probability for HCC based on the LI-RADS classification system (LI RADS 3). Due to the CT findings in the setting of cirrhosis, a provisional diagnosis of HCC was made. Upper endoscopy revealed new multiple umbilicated submucosal nodules in the gastric body. Biopsy and immunostaining consistent with high-grade B-cell lymphoma. Targeted liver biopsy with similar morphology and immunostaining profile consistent with metastatic primary gastric DLBCL. Conclusions The case highlights the importance of recognizing metastatic PGL in patients with underlying cirrhosis to differentiate lymphoma from hepatocellular cancer. Targeted liver biopsies with lymphoma immunostaining are required to make a diagnosis.

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The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma

Cited by 15 publications

References 41 publications

Gastrointestinal lymphoma: the new mimic

Gastrointestinal lymphoma: the new mimic

Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors

Aggressive primary gastric lymphoma (PGL) masquerading as hepatocellular cancer (HCC) in alcoholic cirrhosis

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