Diffuse histiocytic lymphoma presenting with gastrointestinal tract lesions the stanford experience

Abstract

The medical records of all patients with diffuse histiocytic lymphoma (DHL) presenting for treatment at the Stanford University Medical Center between 1970-1978 were reviewed. From this group of 284 patients, 48 were identified with gastrointestinal tract lesions at initial evaluation. Abdominal pain was the most common presenting symptom. Anorexia, weight loss, malaise, and weakness were also common complaints. Twenty percent of these patients noted abdominal masses and 15% experienced gastrointestinal bleeding. Gastric involvement was found in 56% of patients, small intestine in 25%, large intestine in 10%, and pancreas 8%. Following treatment, 83% of Stage IE patients, 43% of Stage IIE patients, and 27% of patients with Stage III and IV DHL achieved durable complete remissions. Considering all stages, a 54% complete remission rate was observed. Of the 26 patients achieving a complete remission, seven have relapsed and the remaining continue free of disease from 6+ to 82+ months. The median survival for patients obtaining a CR was greater than 36 months. Gastrointestinal bleeding or perforation probably as a consequence of therapy was noted 25% of patients. The implications of these findings for improved therapeutic programs and investigations are discussed.

Primary gastric lymphoma – The experience of a General Hospital

“…Our experience of the use of multichemotherapy as primary treatment in patients with unresected tumours has been similar to that reported in the literature (Hande et al, 1978;Rosenfelt & Rosenberg, 1980). Only 3 out of 9 such patients i.e.…”

“…Although we do not disagree with the statement that the application of the Ann-Arbor system is problematic in some cases of lymphomas, its modified from used in our study proved to be quite useful as a prognostic determinant, in accordance with the findings of others (Rosenfelt & Rosenberg, 1980;Hermann et al, 1980;Weingrand et al, 1982).…”

“…On the other hand chemotherapy alone or in combination with curative surgery and/or irradiation has been has been used only rarely in limited disease (Hande et al, 1978;Wiengrand et al, 1982;Maor et al, 1984). This relucance possibly stems from the knowledge that complete response rate with chemotherapy is distinctly low in cases of advanced gastrointestinal lymphomas (Hande et al, 1978;Rosenfelt & Rosenberg, 1980) while complications like perforation and gastrointestinal bleeding are not uncommon (Rosenfelt & Rosenberg, 1980;Hermann et al, 1980;Weingrand et al, 1982 (Weingrand et al, 1982).…”

Combined surgery and chemotherapy for the treatment of primary gastrointestinal intermediate- or high-grade non-Hodgkin's lymphomas

“…Non-Hodgkin's lymphomas (NHLs) are known to arise from extranodal sites with an estimated frequency of 10-30% (Banfi et al, 1968;Freeman et al, 1972;Jones et al, 1973;Rudders et al, 1978;Reddy et al, 1980;Ho et al, 1984;Gospodarowicz et al, 1987). The gastrointestinal tract is the site most frequently affected at diagnosis accounting for about 4-18% of all extranodal forms of NHLs (Freeman et al, 1972;Reddy et al, 1980;Ho et al, 1984;Lewin et al, 1978;Isaacson et al, 1979;Herrmann et al, 1980;Hande et al, 1978;Strauss et al, 1983;Gospodarowicz et al, 1983;Siegert et al, 1985;Carnevali et al, 1987).…”

A prospective study of surgery and adjuvant chemotherapy for primary gastric lymphoma stage II

“…The role of surgery in the management of PGL is to ensure an accurate histopathological diagnosis, reduce tumour bulk, relieve symptoms and prevent bleeding and perforation. Although the actual frequency of chemotherapy-related bleeding or perforation is not clear, the frequency of these complications in unresected patients with gastrointestinal lymphoma reported previously varies from 0% to 20% (Brooks et al, 1983;Gobbi et al, 1984;Rosenfelt et al, 1980). Another important aspect of surgery is tumour staging, and many authors have reported that this is the most important prognostic factor affecting survival (Lim et al, 1977;Shiu et al, 1982;Brooks et al, 1983;Dragosics et al, 1985;Hockey et al, 1987) Any additional treatment is based on the pathological stage, and surgical exploration with gastrectomy is the only means of achieving this.…”