Early gastric lymphoma: A clinicopathologic study of ten patients, literature review, and comparison with early gastric adenocarcinoma

Kitamura, Kazuya; Yamaguchi, Toshiharu; Okamoto, Kazuma; Ichikawa, Daisuke; Hoshima, Masakazu; Taniguchi, Hiroki; Takahashi, Toshio

doi:10.1002/(sici)1097-0142(19960301)77:5<850::aid-cncr7>3.0.co;2-i

Cited by 27 publications

(23 citation statements)

References 46 publications

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“…As for the treatment of the superficial spreading type of early gastric cancer, we must first distinguish it from other diseases, namely the polypoid type of malignant lymphoma, multiple polyposis, and chronic gastritis [28][29][30][31]. After a diagnosis of the superficial spreading type of early gastric cancer is made, surgeons should understand the nature of the disease before operating.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features of the superficial spreading type of early gastric cancer

et al. 1999

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Abstract:Background. During a 10-year period (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995), 59 of 538 patients with early gastric cancer (11.0%) had the superficial spreading type of gastric cancer. We attempted to elucidate the clinicopathological features and investigated the influence of those features on surgical procedures and patient prognoses. Methods. These 59 superficial spreading lesions were analyzed with respect to macroscopic type, lymph node (LN) metastasis, recurrent pattern, and method of surgical operation. In addition, the lesions were compared with those of 393 other patients with small-sized cancer. Results. In both groups, the IIc type macroscopic lesion occurred most frequently, and the depressed subtype occurred more frequently than the elevated subtype. There was no significant histologic difference between the groups. The incidence of LN metastasis was 8.7% in early gastric cancer, 7.1% in small-sized cancer, and 20.3% in superficial spreading cancer. The incidence of lymphovascular invasion was 24.4% in small-sized cancer and 50.8% in superficial spreading cancer. The incidences of LN metastasis and lymphovascular invasion were greater in superficial spreading cancer than in smallsized cancer. Despite extensive preoperative examination, determination of the tumor margin was impossible in 26 of the 59 patients with superficial spreading cancer. The incidence of recurrence was 2.0% in small-sized cancer and 5.1% in superficial spreading cancer. Conclusions. A wide resection with extensive lymph node dissection (D2 or more) seems to be an appropriate treatment for the superficial spreading type of early gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Clinicopathological features of the superficial spreading type of early gastric cancer

et al. 1999

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“…However Turkish and Indian series suggested that intestinal lymphomas have been more predominant than gastric lymphoma in those regions [12,13] . Gastric lymphomas are prevalent in patients aged more than 50 years, however it still has been reported in the second decade of life [14,15] . Reported median age is 60-65 years and males are 2-3 times more affected than females [16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

Primary gastric lymphoma

Al-Akwaa¹,

Siddiqui²,

Al-Mofleh³

2004

WJG

102

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AIM:The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available. METHODS:After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma. RESULTS:Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration. CONCLUSION:We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications.Al-Akwaa AM, Siddiqui N, Al-Mofleh IA. Primary gastric lymphoma.

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“…Primary gastric lymphoma arises from the mucosal or submucosal layer and spreads diffusely into the mucosa and submucosa, and the tumor extends along the surface of the gastric wall, usually without lymph node involvement (6,17,35) . In this situation, gastroscopy may not be capable of detecting the lesion, due to the lack of suggestive alterations, such as polypoid or ulcerated lesions or also diffuse thickening of gastric folds (14,30) .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, postoperative chemotherapy may be used to inhibit recurrence of neoplasm in the remaining stomach and eradicate microscopic residual disease (16,23,29) . Radiotherapy directed towards the framework supporting the stomach and the para-aortic lymph nodes has been demonstrated to be beneficial for patients with involvement of lymph nodes and disease that is locally advanced or cannot be extirpated (13,17) . Radiation was used post-operatively in high-and low-grade lymphomas, for any residual tumors in stages I and II in order to improve the disease free survival (17) .…”

Section: Discussionmentioning

confidence: 99%

“…Radiotherapy directed towards the framework supporting the stomach and the para-aortic lymph nodes has been demonstrated to be beneficial for patients with involvement of lymph nodes and disease that is locally advanced or cannot be extirpated (13,17) . Radiation was used post-operatively in high-and low-grade lymphomas, for any residual tumors in stages I and II in order to improve the disease free survival (17) . Nevertheless, the use of radiotherapy in the treatment of primary gastric lymphoma remains controversial, given the absence of randomized and prospective studies evaluating its efficacy, especially as an isolated treatment.…”

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confidence: 99%

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Curative resection plus adjuvant chemotherapy for early stage primary gastric non-Hodgkin's lymphoma: a retrospective study with emphasis on prognostic factors and treatment outcome

Waisberg¹,

Andre²,

Franco

et al. 2006

Arq. Gastroenterol.

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-Background -There is controversy regarding the optimal therapy for primary non-Hodgkin gastric lymphoma with some authors defending surgical extirpation either alone or in association with radiotherapy and or chemotherapy, especially in relation to the earlier stages of the disease. Aim -To analyze the clinical-pathological features and the results of management approaches for patients with primary early-stage non-Hodgkin's lymphoma of the stomach operated in Surgical Gastroenterology Department, "Hospital do Servidor Público Estadual", São Paulo, SP, Brazil. The literature is reviewed to highlight the aspects of diagnosis, prognostic factors and role of the various treatment regimens. Method -Sixteen patients with primary early-stage gastric lymphoma underwent curative surgical treatment. The variables analyzed were age, sex, location, size, type of surgery, number of lesions, depth of invasion, histological type in accordance with Kiel's classification, involvement of lymph nodes, Ann Arbor stage classification modified by Musshoff and Schmidt-Vollmer, histological grade, margins, adjuvant therapy, clinical course and survival. Results -Ten patients (62.5%) underwent subtotal gastrectomy and six (37.5%) underwent total gastrectomy. The majority (9/56.2%) of the lesions were located in the antrum. Single lesions (10/62.5%) were more frequent than multiple lesions (6/37.5%). Thirteen patients (81.2%) were classified as stage IE and three (18.7%) as stage IIE1. Primary gastric lymphoma classified histologically as low or high grade was presented by 10 (62.5%) and 6 (37.5%) patients, respectively. The most frequent histological types were the lymphoplasmocytic cytoid (4/25.0%) and centroblastic (4/25.0%). Ten patients (62.5%) received adjuvant treatment (chemotherapy and/or radiotherapy). Nine patients (56.2%), all in stage IE, reached a survival greater than 5 years and of these eight (50.0.%) had received adjuvant therapy. Two (12.5%) patients with stage IIE1 presented peritoneal relapse and died 3.0 years and 3.5 years after their respective operations. The mean overall survival was 42,5 months. Conclusions -Among the patients with primary early-stage gastric lymphoma (IE and IIE1), the gastric resection enabled an accurate clinicopathological staging, in addition to obtaining sufficient material for histopathological study and extirpation of the lesion. Furthermore, for patients with stage IE disease, the gastric resection combined with adjuvant therapy was associated with a greater than 5-year survival. Until prospective randomized studies are realized in order to evaluate the real efficacy of the different types of treatment for primary early-stage gastric lymphoma, management approaches should be individually tailored. HEADINGS -Lymphoma. Non-Hodgkin's lymphoma. Gastric neoplasms. Prognostic factors. Survival. lymphomas, mucosa-associated lymphoid tissue (MALT) and low-grade lymphomas (12,16,27,28,31) . Due to the relative rarity of the tumor, few centers have accumulated an adequate number of pat...

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Early gastric lymphoma: A clinicopathologic study of ten patients, literature review, and comparison with early gastric adenocarcinoma

Abstract: Surgical treatment with a wide resection of the stomach and extensive lymph node dissection is necessary for early gastric lymphomas.

Cited by 27 publications

References 46 publications

Clinicopathological features of the superficial spreading type of early gastric cancer

Clinicopathological features of the superficial spreading type of early gastric cancer

Primary gastric lymphoma

Curative resection plus adjuvant chemotherapy for early stage primary gastric non-Hodgkin's lymphoma: a retrospective study with emphasis on prognostic factors and treatment outcome

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