Clinical and Endoscopic Presentation of Primary Gastric Lymphoma: An Italian Multicenter Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4664-4664
Author(s):  
Caterina Patti ◽  
A. Zullo ◽  
L. Tedeschi ◽  
F. Di Raimondo ◽  
C. Hassan ◽  
...  
Keyword(s):  
Gastric Lymphoma ◽  
P Value ◽  
Low Grade ◽  
Primary Gastric Lymphoma ◽  
Chi Squared ◽  
Stage Ia ◽  
Frequent Site ◽  
H Pylori ◽  
Intestinal Lymphomas ◽  
Few Data

Abstract Background. The stomach is the most frequent site of intestinal lymphomas. However, few data are available on the clinical-endoscopic presentation of gastric lymphoma as well as on possible differences in clinical pattern and endoscopic features between low-grade (LG) and high-grade (HG) lymphomas. In this study, we evaluated such aspects on consecutive primary gastric lymphoma patients observed in the last 12 years (1993–2004) in four Italian Hospitals (1 North, 2 Centre, 2 South). Methods. Clinical, histological, and endocospic records of consecutive patients diagnosed with LG or HG gastric lymphoma were retrieved and accurately evaluated. Symptoms were categorized as “alarm” (anaemia/melaena/heamorrage, persistent vomiting, weight loss) or “no alarm” (epigastric/abdominal pain, heartburn, dyspepsia/bloating). The endoscopic findings were classified as “normal” (no macroscopic lesions) or “abnormal” (ulcer, erosions, nodular pattern, hypertrophic folds, polypoid mass). Statistical analysis was carried out by using the Chi squared test. Results. During the study period, 143 patients with primary gastric lymphoma were detected. Overall, 61 patients were observed in the first 6 years and 82 in the last 6 years. The main results of the study are summarized in the table 1. Conclusions. The incidence of primary gastric lymphoma seems to be increasing. The overall prevalence of alarm symptoms is quite low, and they may be absent in near 75% of LG lymphoma patients. Moreover, contrarily to HG, LG lymphoma may present as a normal endoscopic finding and it is more frequently associated with H. pylori infection. At diagnosis, HG lymphoma is more frequently detected in an advanced stage as compared to LG lymphoma. Overall (143 patients) LG lymphoma (73 patients) HG lymphoma (70 patients) P value Age (mean ± SD) yrs 59.5 ± 14.2 59.4 ± 13.3 59.7 ± 15.1 0.4 Sex (M /F) 83/60 44/29 39/31 0.6 Alarm symptoms 57 (40%) 19 (26%) 38 (54%) 0.0009 Normal endoscopy 15 (10%) 15 (20%) 0 (0%) 0.0004 H. pylori infection 66 (73%) 47 (86%) 27 (39%) <0.0001 Stage (IA />IA) 78/65 58/15 20/50 <0.0001

Histologic Changes of the Gastric Mucosa Associated With Primary Gastric Lymphoma in Endoscopic Biopsy Specimens

2000 ◽  
Vol 124 (11) ◽  
pp. 1628-1631
Author(s):  
Julián Arista-Nasr ◽  
Roberto Herrera-Goepfert ◽  
Minerva Lazos-Ochoa ◽  
Raúl Pichardo
Keyword(s):  
Gastric Mucosa ◽  
Intestinal Metaplasia ◽  
Gastric Lymphoma ◽  
Endoscopic Biopsy ◽  
Glandular Epithelium ◽  
Low Grade ◽  
Lymphoid Follicles ◽  
Primary Gastric Lymphoma ◽  
Endoscopic Biopsies ◽  
H Pylori

Abstract Context.—Recently, we have observed intestinal metaplasia, atrophy, and dysplasia in the mucosa adjacent to primary gastric lymphoma (PGL) in gastrectomy specimens. Objective.—To determine the frequency and type of epithelial disorders at the histopathologic level in the mucosa adjacent to PGL in endoscopic specimens. Design.—We studied 54 endoscopic biopsies from patients harboring PGL. We searched for the following morphologic changes in the gastric mucosa: intestinal metaplasia; atrophy; dysplasia; epithelial erosion; and atypical regeneration of the glandular epithelium. Other nonepithelial findings such as lymphoid follicles, Helicobacter pylori, and lymphoma grade, were also recorded. For comparative purposes, 50 endoscopic biopsies with gastric adenocarcinoma and 50 biopsies with chronic gastritis associated with H pylori infection were also studied. Results.—The 54 biopsies included 28 (52%) low-grade and 26 (48%) high-grade PGLs. We found intestinal metaplasia in 32 biopsies (59%), atrophy in 20 biopsies (37%), dysplasia in 2 biopsies (4%), erosion of the epithelium in 33 biopsies (61%), and atypical regenerative changes of the glandular epithelium in 10 biopsies (19%). Lymphoid follicles were found in 21 biopsies (39%), and H pylori was demonstrated in 31 biopsies (57%). When groups were compared, the frequency of epithelial changes in biopsies from patients with PGL and adenocarcinoma was similar. Intestinal metaplasia or atrophy were present in only 10% of biopsies from patients with gastritis, and dysplastic glands were not identified. Conclusions.—Biopsies from patients with PGL showed chronic damage of the gastric mucosa at diagnosis, including precancerous conditions. Intestinal metaplasia and atrophy were among the most frequent disorders, but dysplasia was also occasionally present. Endoscopists and pathologists must be acquainted with such changes and look for them in the initial biopsy, as well in subsequent samples. This practice is particularly important when reviewing biopsies from patients with low-grade mucosa-associated lymphoid tissue (MALT)-lymphomas who are eligible for eradication treatment for H pylori.

scholarly journals Primary Gastric Lymphoma of MALT: Considerations of Pathogenesis, Diagnosis and Therapy

2000 ◽  
Vol 14 (suppl d) ◽  
pp. 44D-50D ◽  
Author(s):  
Wolfgang Fischbach
Keyword(s):  
Histological Grade ◽  
Therapeutic Option ◽  
Gastric Lymphoma ◽  
Treatment Modalities ◽  
Low Grade ◽  
Distinct Entity ◽  
Primary Gastric Lymphoma ◽  
Grade Of Malignancy ◽  
H Pylori ◽  
Stage 1

Primary gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct entity with its own histological classification. Epidemiological, histomorphological, molecular biological and experimental data clearly underline that infection of the gastric mucosa byHelicobacter pyloriplays an important role in both the development and progression of MALT lymphoma. Considering the histological grade of malignancy and dissemination (stage) of the disease as decisive prognostic factors, and therapeutic determinants, endoscopic bioptical diagnosis and endoscopic ultrasound are of particular importance. In cases of localized (stage 1), low grade lymphoma, eradication ofH pylorioffers a promising and fascinating therapeutic option. Surgical resection, radiotherapy or chemotherapy, and their combination, have proven to be effective treatment modalities. There is a need to clarify whether operative or conservative therapeutic strategies should be favoured in the future.

Prevention and Treatment of Low-grade B-cell Primary Gastric Lymphoma by Anti-H. Pylori Therapy

1995 ◽  
Vol 21 (2) ◽  
pp. 118-122 ◽  
Author(s):  
Giovanni Cammarota ◽  
Antonio Tursi ◽  
Massimo Montalto ◽  
Alfredo Papa ◽  
Giovanna Branca ◽  
...  
Keyword(s):  
B Cell ◽  
Gastric Lymphoma ◽  
Low Grade ◽  
Primary Gastric Lymphoma ◽  
Prevention And Treatment ◽  
H Pylori

scholarly journals Evaluation of the Association of Nine Helicobacter pylori Virulence Factors with Strains Involved in Low-Grade Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

2004 ◽  
Vol 72 (2) ◽  
pp. 880-888 ◽  
Author(s):  
Philippe Lehours ◽  
Armelle Ménard ◽  
Sandrine Dupouy ◽  
Bernard Bergey ◽  
Fréderique Richy ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Mucosa ◽  
Virulence Factors ◽  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Gastric Lymphoma ◽  
Gastric Malt Lymphoma ◽  
Low Grade ◽  
H Pylori ◽  
Few Data

ABSTRACT Helicobacter pylori has been associated with the development of two malignant diseases: gastric adenocarcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Although the cag pathogenicity island, especially the cagA gene, has been linked with adenocarcinoma, few data concerning H. pylori pathogenic factors involved in low-grade gastric MALT lymphoma are available. The goal of this study was to analyze the prevalence of and correlation between genes coding for seven H. pylori virulence factors (cagA, cagE, vacA, iceA, babA, hopQ, and oipA) and two novel adhesins (sabA and hopZ) by comparing a collection of 43 H. pylori strains isolated from patients with low-grade gastric MALT lymphoma to 39 strains isolated from age-matched patients with gastritis only. Our results show that taken individually, none of the nine genes tested can be considered associated with MALT strains and allow us to conclude that MALT pathogenesis is not linked with more proinflammatory H. pylori strains. We demonstrated that in patients infected with strains harboring the iceA1 allele, sabA functional status, and hopZ “off” status, the odds of developing a MALT lymphoma were 10 times higher. However, the low prevalence of such strains (10 of 43 MALT strains) renders this triple association a low-sensitivity marker for MALT strains. Our data confirmed that H. pylori virulence factors are correlated with one another. If the involvement of H. pylori in MALT lymphoma is well established, the pathomechanism by which gastric lymphoma occurs remains to be identified.

scholarly journals Can we eradicate gastric MALT-lymphoma?

2013 ◽  
pp. 154-158
Author(s):  
Angelo Zullo ◽  
Cesare Hassan ◽  
Francesca Cristofari ◽  
Claudia Iegri ◽  
Nicoletta Villiva ◽  
...  
Keyword(s):  
Malt Lymphoma ◽  
Early Stage ◽  
Gastric Lymphoma ◽  
Survival Rates ◽  
Antibody Therapy ◽  
Gastric Malt Lymphoma ◽  
Low Grade ◽  
Success Rates ◽  
H Pylori

The incidence of primary gastric lymphoma in Italy is considerably higher than that observed in the rest of Europe. It is widely accepted that gastric B-cell, low-grade mucosalassociated lymphoid tissue (MALT) lymphoma is caused by specific host-bacterial interactions that occur during Helicobacter pylori infection. This review examines recent findings on the origins, diagnosis, treatment, and follow-up of gastric MALT lymphomas. Clinical and endoscopic findings at diagnosis vary widely. In a substantial number of cases, the patient presents only vague dyspeptic symptoms or poorly defined abdominal pain with no macroscopic lesions on the gastric mucosa. Review of data from 32 trials in which a total of 1,387 MALT-lymphoma patients of the stomach were treated solely with H. pylori eradication revealed high remission rates when the disease is treated early (stage I-II1). Neoplasia confined to the submucosa, antral localization of tumors, and negativity for the API2-MALT1 translocation were associated with a high probability of remission following H. pylori eradication. When the latter approach is not sufficient, radiotherapy, chemotherapy and, in selected cases, surgery are associated with high success rates; data on the efficacy of monoclonal antibody therapy (rituximab) are still limited. Five-year survival rates are higher than 90%. Patients whose tumors have been eliminated require close, long-term endoscopic follow-up since recurrence has been reported in some cases. Broader clinical follow-up is also advisable because the incidence of other solid tumors and of cardiovascular events is reportedly increased in these patients.

scholarly journals Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481877825 ◽  
Author(s):  
Luis Miguel Juárez-Salcedo ◽  
Lubomir Sokol ◽  
Julio C. Chavez ◽  
Samir Dalia
Keyword(s):  
Malt Lymphoma ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Wide Spectrum ◽  
Gastric Lymphoma ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Predisposing Factor ◽  
Primary Gastric Lymphoma ◽  
Non Hodgkin Lymphoma

Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma and represents a wide spectrum of disease, ranging from indolent low-grade marginal zone lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma to aggressive diffuse large B-cell lymphoma. The PGL is a relatively rare cancer and easily misdiagnosed due to its unspecific symptoms of the digestive tract. The medical literature and ongoing clinical trials were reviewed on the clinical presentation, diagnosis, prognosis, prevention, and treatment of PGL. Primary gastric lymphoma is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Chronic gastritis secondary to Helicobacter pylori ( H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Magnetic resonance imaging and endoscopic ultrasonography have helped in staging of these cancers. The clinical course and prognosis of this disease are dependent on histopathological subtype and stage at the time of diagnosis. A global therapeutic approach to the cure of PGL has completely changed over the past 10 years, including innovative and conservative options to reduce treatment toxicity. Due to the rarity of PGL, many aspects of this neoplasm are still controversial. The incidence of this disease is increasing, making it necessary for clinicians to understand the clinical symptoms, workup, and treatment of these lymphomas.

scholarly journals Are Histopathological Changes of H. pylori Infection in Young Dyspeptic Patients Necessitate Endoscopy?

2019 ◽  
Vol 7 (19) ◽  
pp. 3211-3215
Author(s):  
Wafaa Redha Mohammed Al-Sabbagh ◽  
Alaa Qasim Yahya ◽  
Rasha Abdelraouf Alsafi
Keyword(s):  
Helicobacter Pylori ◽  
Gastric Lymphoma ◽  
Young Patients ◽  
Chronic Atrophic Gastritis ◽  
Gastric Biopsy ◽  
P Value ◽  
Histopathological Changes ◽  
Gastric Biopsies ◽  
Antigen Tests ◽  
H Pylori

BACKGROUND: Helicobacter pylori is an important gastrointestinal infective bacteria with many serious complications including gastric erosions and ulceration, duodenal ulcer, gastric carcinoma and MALT gastric lymphoma. The gastric biopsy is commonly performed in H. pylori-positive dyspeptic individuals, and many previous researchers studied the histopathological features of infected gastric biopsies however little previous studies focused on the histopathological findings in young population in comparison to the older one. AIM: To make a focus on the histopathological effects of H. pylori infection in young patients compared with the older one and predicts the need for endoscopy in this population, also to estimates the prevalence of infection in Iraqi patients. MATERIAL AND METHODS: the sample for this study is 180 patients in total, they attended Marjan medical city in Iraq for dyspepsia of more than 3 months and prepared for OGD. Patients asked for their permission to do immunological tests for H. pylori. Both serology for H. pylori antibodies and stool for antigen tests are used, and the case is included in the study only if both tests were positive, after OGD, the gastric biopsies are processed and examined histopathologically. RESULTS: Normal gastric biopsy is the most common histopathological finding in young (< 25 years) patients (75%) while chronic atrophic gastritis is the most common one in patients > 25 years age (57%). The prevalence of Helicobacter pylori infection in dyspeptic patients was 73.3%, the correlation between infection and sex was insignificant (p-value 0.06), and no significant correlation between infection and age (p-value 0.07) was concluded. CONCLUSION: H. pylori-related histopathological changes of gastric mucosa in young (< 25 years) are commonly mild and does not necessitate endoscopy at this age unless there are alarming signs.

Complete Remission of Primary High-Grade B-Cell Gastric Lymphoma After Cure of Helicobacter pylori Infection

2001 ◽  
Vol 19 (7) ◽  
pp. 2041-2048 ◽  
Author(s):  
Andrea Morgner ◽  
Stephan Miehlke ◽  
Wolfgang Fischbach ◽  
Wolfgang Schmitt ◽  
Hans Müller-Hermelink ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Complete Remission ◽  
B Cell ◽  
Gastric Lymphoma ◽  
Eradication Therapy ◽  
Lymph Node Involvement ◽  
Low Grade ◽  
Resected Stomach ◽  
High Grade ◽  
H Pylori

PURPOSE: Treatment of low-grade gastric mucosa-associated lymphoid tissue lymphoma by eradication of Helicobacter pylori is reported to result in complete lymphoma remission in approximately 75% of cases. The effect that cure of the infection has on the course of a primary high-grade gastric lymphoma is largely uncertain. The aim of this study was to report the effect of cure of H pylori infection exerted in patients with high-grade B-cell gastric lymphoma. PATIENTS AND METHODS: Eight patients (4 males and 4 females; age range, 26 to 85 years) with H pylori infection and high-grade lymphoma received eradication therapy before planned treatment. The effect of H pylori eradication on the course of high-grade lymphoma was assessed by analysis of surgical specimens (n = 2) or endoscopic biopsies (n = 6). RESULTS: H pylori eradication was successful in all patients and led to complete remission of the lymphoma in seven patients. One patient has experienced partial remission. Two patients were referred to surgery, one of whom (stage II1E) had lymph node involvement, and the histologic work-up of the resected stomach revealed residual infiltrates of a low-grade lymphoma, which prompted consolidation chemotherapy. In one patient (initially stage I1E), abdominal lymphoma developed 6 months after eradication therapy, which regressed completely after chemotherapy. In four patients, no further treatment was given. Six patients continue in complete remission (range, 6 to 66 months). CONCLUSION: Primary high-grade B-cell gastric lymphoma in stages IE through IIE1 associated with H pylori may regress completely after successful cure of the infection. Prospective trials are needed to investigate this treatment in larger numbers of patients.

scholarly journals Onset and Progression of Precancerous Lesions on Gastric Mucosa of Patients Treated for Gastric Lymphoma

2020 ◽  
Vol 29 (1) ◽  
pp. 27-31
Author(s):  
Angelo Zullo ◽  
Angela Rago ◽  
Stefano Felici ◽  
Stefano Licci ◽  
Lerenzo Ridola ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Mucosa ◽  
Malt Lymphoma ◽  
Precancerous Lesions ◽  
Gastric Lymphoma ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Primary Gastric Lymphoma ◽  
Low Grade Dysplasia

Background and Aims: Patients with primary gastric lymphoma are at an increased risk of developing gastric cancer. Data on gastric precancerous lesions development in these patients are scanty. We assessed gastric precancerous lesions in a cohort of patients with primary lymphoma. Methods: Data of patients with primary gastric lymphoma [mucosa-associated lymphoid tissue (MALT)- lymphoma or diffuse large B-cell lymphoma (DLBCL)] were analysed. Multiple (>10) biopsies were performed on gastric mucosa at each endoscopic control, beyond macroscopic lesions. Presence and distribution of intestinal metaplasia (IM) at baseline, the onset at follow-up, and progression through the stomach or transformation in the incomplete IM type were assessed. The onset of neoplastic lesions was recorded. Results: Data of 50 patients (mean age of 63.6 ± 10.7 years; M/F: 25/25), including 40 with MALT-lymphoma and 10 with DLBCL, with median follow-up of 30.5 months (range: 9-108) and a median of 6 endoscopic controls (range: 3-14) were evaluated. At entry, IM was present in 12 (24%), and it developed in other 22 (57.9%) patients at a median follow-up of 6 (range: 3-40) months. Overall, progression of IM was observed in 7 (21.2%) cases, including extension in the stomach (n=5) or transformation into the incomplete type (n=2). Low-grade dysplasia was detected in 4, and indefinite dysplasia in other 7 patients. In one patient, low-grade dysplasia had progressed to high-grade and gastric adenocarcinoma of the fundus. Conclusions: Our data found a frequent onset and rapid progression of precancerous lesions on gastric mucosa of lymphoma patients. This observation could explain the increased incidence of metachronous gastric cancer in these patients.

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