Endoscopic criteria for diagnostics of various macroscopic variants of non-Hodgkin gastric lymphomas

According to most investigators, stomach is the most common site of gastrointestinal lymphomas, but endoscopic semiotics and diagnostics of these lesions is not sufficiently developed.

Aim: to develop criteria for the diagnosis of endoscopic non-Hodgkin lymphomas (NHL) of the stomach.

Materials and methods: We studied endoscopic view of gastric lymphoma in 250 patients, in 160 (64%) patients lesions were regarded as the primary, and in 90 (36%) – as secondary. In our study all patients underwent standard videoendoscopic examination of the stomach, which included examination with magnification of 115 times, together with an analysis of microvascular picture with narrow spectrum analysis of mucosal and submucosal layers of the stomach wall, followed with chromogastroscopy using 0.4% solution of indigo carmine and endoscopic ultrasound. The diagnosis of lymphoma was verified by morphological and immunohistochemical methods.

Results: According to our observations duration of the period of the presence of gastroenterological diseases until diagnosing of a tumor in the group of patients with primary lymphoma of the stomach is very variable: during the first 3 months diagnosis was established in 30.6% (n=49) of patients, during 6 months – in 18.1% (n=29) of patients, during period from 6 to 12 months in 15.6% (n=25) of patients and it should be noted that nearly a third of patients (27.5%, n=44) diagnosis of primary gastric lymphoma was established after one year. Macroscopic forms of gastric tumor was presented by the following variants: exophytic – in 22 patients (8.8%), infiltrative – in 54 (21.6%), ulcerative – in 37 (14.8%), infiltrative-ulcerous – in 71 (28.4% ), gastritis-like - in 36 (14.4%) and mixed - in 30 (12.0%)..

Another direction of our study was to identify the characteristics of the macroscopic manifestations depending on the morphological variant of gastric lymphoma. According to presented data gastritis-like variant dominated in patients with MALT-lymphoma (in 34.3%), infiltrative-ulcerous variant dominated in patients with diffuse large B-cell lymphoma of MALT type, as in patients with diffuse large B-cell lymphoma - in 45.0% and 41.1% respectively. Infiltrative variant was most frequent in patients with follicular lymphoma (31.8%), and ulcerative variant was dominated in patients with Burkitt's lymphoma (60.0%).

Conclusion: the most informative diagnostic criteria for endoscopic gastric NHL were established.

1. Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin’s lymphomas: distributions of the major subtypes differ by geographic locations. Non-Hodgkin’s Lymphoma Classification Project. Ann Oncol. 1998 Jul;9 (7):717–20.

2. Capelle LG, de Vries AC, Looman CW, Casparie MK, Boot H, Meijer GA, Kuipers EJ. Gastric MALT lymphoma: epidemiology and high adenocarcinoma risk in a nation-wide study. Eur J Cancer. 2008 Nov;44 (16):2470–6.

3. Maynadi M. Epidemiology of lymphoma. Rev Prat. 2010 Jan 20;60 (1):33–8.

4. Parvez T, Behani A, Ali A. Primary gastric lymphoma. J Coll Physicians Surg Pak. 2007 Jan;17 (1):36–40.

5. Peng AP, Chen MK, Shen L, Luo HS, Chen YH. Simultaneous primary low-grade mucosa-associated lymphoid tissue lymphoma of stomach and duodenum. Digestion. 2010;81 (2):130–3.

6. Ruskon -Fourmestraux A. MALT gastric lymphomas. Rev Med Interne. 2004 Aug;25 (8):573–81

7. Shukla K, Patel T, Shukla J, Palanki S. Primary gastrointestinal lymphoma — a clinicopathologic study. Indian J Pathol Microbiol. 2007 Apr;50 (2):296–9

8. Zinzani PL. Primary gastric diffuse large-cell lymphoma. Leuk Lymphoma. 2006 Jul;47 (7):1201–2