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

Abstract 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.

Download Full-text

Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

Cancer Control ◽

10.1177/1073274818778256 ◽

2018 ◽

Vol 25 (1) ◽

pp. 107327481877825 ◽

Cited By ~ 21

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.

Download Full-text

CHOP Followed by Radiotherapy for Localized Aggressive Primary Gastric Lymphoma: Results of a Multi Center Phase II Study.

Blood ◽

10.1182/blood.v104.11.3306.3306 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3306-3306

Author(s):

Yeon Hee Park ◽

Won Seog Kim ◽

Baek-Yeol Ryoo ◽

Sung Hyun Yang ◽

Mi Sook Kim ◽

...

Keyword(s):

Confidence Interval ◽

Response Rate ◽

Performance Status ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Complete Response ◽

World Health ◽

High Grade ◽

Chop Chemotherapy ◽

Primary Gastric Lymphoma

Abstract Classically, the treatment of localized gastric lymphoma was based on surgery, alone or followed by chemotherapy and/or radiation therapy (RT). The need for surgery as a diagnostic procedure and staging tool has decreased. CHOP chemotherapy followed by RT has been a standard first-line treatment for localized stage I–II nodal Diffuse Large B-cell Lymphoma (DLBL). The purpose of this study is to define role of CHOP followed by RT for localized high-grade primary gastric lymphoma, just as nodal localized DLBL. The patient population in this study consisted of newly diagnosed patients of at least 18 years of age with histologically documented localized high-grade primary gastric lymphoma. The stage of each patient’s disease was assigned according to the Ann Arbor staging system as modified by Musshoff. Patients were expected to have performance status of 0, 1, or 2 according to the World Health Organization scale. Patients were to receive a total of four cycle of CHOP chemotherapy given every 21 days. The planned doses of radiation were total 40.0 Gy. From August 1998 to December 2003, 55 patients were registered. Five patients (9%) were excluded from analysis due to withdrawal of consent (n=1), ineligibility (n=2), incorrect histology (n=1), and inadequate data for response evaluation (n=1). Fifty patients were included in this analysis. The median age of the 25 female and 25 male patients was 54.5 years (range 21–73 years), and most of the patients (92%) had a good performance status (0 or 1). All of the patients were DLBL patients. Among these 50 DLBL patients, eight patients included low-grade lymphoma component. The overall response rate to the CHOP chemotherapy was 94% (95% confidence interval, 87% to 100%) in the intent-to-treat population. Forty- one (82%) of 50 patients (95% confidence interval, 71% to 93%) achieved complete response (CR), and 6 patients (12%) had partial response (PR). Three patients were not evaluable. Finishing RT, five patients who were in PR after chemotherapy eventually converted to CR status. Therefore, overall complete response rate was 92%. With median follow-up period of 30 months, 2-year progression-free and overall survival rate were 92%. No treatment related death or serious adverse event was found. Neutropenic fever was observed at 12 patients. Grade 3 or more serious adverse events were shown at 20 patients. However, no treatment-related death was found. Anemia and thrombocytopenia were common. Non-hematologic toxicities were relatively mild. Major non-hematologic toxicities were nausea, fatigue and peripheral neuropathy. Only one patient underwent salvage gastrectomy after starting RT due to pyloric obstruction caused by tumor deformity. This organ preserving combined treatment modality is highly effective and well tolerable for patients with localized gastric DLBL.

Download Full-text

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

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-516 ◽

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.

Download Full-text

Clinical usefulness of PET/CT in initial staging and response evaluation of primary gastric lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e19541 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e19541-e19541

Author(s):

J. Yi ◽

S. Kim ◽

S. Lee ◽

S. Park ◽

Y. Ko ◽

...

Keyword(s):

Ct Scan ◽

B Cell ◽

Cell Lymphoma ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Ct Scans ◽

Primary Gastric Lymphoma ◽

Pet Ct ◽

Pet Ct Scan

e19541 Background: Positron emission tomography (PET)/computed tomography (CT) scan has a well-established role in the management of non-Hodgkin's lymphoma (NHL). However, in case of the primary gastric lymphoma, which is the most frequent extranodal NHL, the role of PET/CT scan is still controversial. Methods: We retrospectively analyzed 42 patients with primary gastric lymphoma who underwent PET/CT scans; 32 patients with diffuse large B-cell lymphoma (DLBCL) and 10 patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) were analyzed. The PET/CT scans were compared with clinicopathologic features and the results of CT and endoscopy. After corresponding treatment, response was evaluated by conventional CT scans or PET/CT scans and endoscopy with biopsy Results: Nine patients were up-staged based on the results of their PET/CT scan compared to CT (7 DLBCL, 2 MALT lymphomas) while six patients were down-staged by the PET/CT scan. The high SUVmax group, defined as SUVmax ≥ median value, was significantly associated with an advanced Lugano stage (P < 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Although not statistically significant, there was a tendency of inferior outcome in the group with high SUVmax. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. Conclusions: PET/CT scan can help staging patients with primary gastric lymphoma, and the maximum SUV has possibility to have prognostic value. However, the residual FDG uptake observed during follow-up should be interpreted cautiously in association with the results of endoscopy and multiple gastric biopsies. No significant financial relationships to disclose.

Download Full-text

Clinicopathologic study of primary gastric lymphoma of B cell phenotype with special reference to low-grade B cell lymphoma of mucosa-associated lymphoid tissue among the Japanese

Pathology International ◽

10.1111/j.1440-1827.1995.tb03403.x ◽

1995 ◽

Vol 45 (11) ◽

pp. 832-845 ◽

Cited By ~ 19

Author(s):

Kayoko Akaza ◽

Tadashi Motoori ◽

Shigeo Nakamura ◽

Takashi Koshikawa ◽

Kuniyoshi Kitoh ◽

...

Keyword(s):

B Cell ◽

Special Reference ◽

Lymphoid Tissue ◽

Cell Lymphoma ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Cell Phenotype ◽

Low Grade ◽

Primary Gastric Lymphoma ◽

Clinicopathologic Study

Download Full-text

Primary Gastric Lymphoma: Pathobiology, MALT Lymphoma, Diffuse Large B Cell Lymphoma and Burkitt Lymphoma

10.1007/978-981-16-6026-9_17 ◽

2021 ◽

pp. 177-190

Author(s):

Kim Vaiphei

Keyword(s):

B Cell ◽

Malt Lymphoma ◽

Burkitt Lymphoma ◽

Cell Lymphoma ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Primary Gastric Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

Download Full-text

S2552 Aggressive Primary Gastric Lymphoma (PGL) Masquerading as Hepatocellular Cancer (HCC) in Cirrhosis

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000712256.23326.6e ◽

2020 ◽

Vol 115 (1) ◽

pp. S1343-S1343

Author(s):

Moiz Ahmed ◽

Ahmed AL-Khazraji ◽

Bhanu Singh ◽

Umer Syed ◽

Rupa Sharma ◽

...

Keyword(s):

Gastric Lymphoma ◽

Hepatocellular Cancer ◽

Primary Gastric Lymphoma

Download Full-text

Mitochondrial Changes in Cholestasis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100094553 ◽

1972 ◽

Vol 30 ◽

pp. 258-259

Author(s):

F. G. Zaki

Keyword(s):

Biliary Obstruction ◽

Alcoholic Cirrhosis ◽

Ultrastructural Changes ◽

List Type ◽

Common Occurrence ◽

Extrahepatic Cholestasis ◽

Mitochondrial Alteration ◽

Extrahepatic Biliary Obstruction ◽

Liver Biopsies ◽

Mitochondrial Anomalies

Alterations of liver cell mitochondria represent pathologic phenomenon of a fundamental nature. Mitochondrial anomalies have been often described in association with cholestasis. In attempt to determine whether a given pattern of mitochondrial alteration has any correlation with the cause of cholestasis, liver biopsies were examined from 38 patients showing :a. extrahepatic cholestasis due to complete or partial extrahepatic biliary obstruction (8 cases proven at operation)b. intrahepatic cholestasis due to drugs (9 cases), viral hepatitis (6 cases) and alcoholic cirrhosis (15 cases).Mitochondria exhibiting ultrastructural changes due to aging or to the ‘wear and teart’ processes were not considered. In this study, the only profound and most prominent mitochondrial deformation was reported on basis of their common occurrence in randomly examined sections.

Download Full-text