Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

Abstract

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.

MALT lymphoma: epidemiology, clinical diagnosis and treatment

“…Pathogenesis of primary gastric lymphoma could be associated with another risk factors like hepatitis B virus, human immunodeficiency virus (HIV), Epstein-Barr virus and human T- cell lymphotropic virus type 1 [ 4 ].…”

“…The most important prognostic factor for PGL is the international prognosis index (IPI). This index includes age (> 60 years), poor performance status, elevated LDH and advanced stage [ 4 ].…”

“…In September 2017, a new MALT lymphoma prognostic index (MALT-IPI) was published [ 4 ]. Thieblemont et al claimed that age > 70 years, elevated LDH and Ann Arbor stage III or IV are the most important prognostic factors, being an important tool for MALT lymphoma patients with poor outcomes [ 4 ]. The literature reported that t(11;18) is associated with resistance to antibiotic therapy that gives a poor prognosis [ 4 ].…”

“…The incidence of developing PGL is 2–3 times higher in males than in females [ 4 ]. MALT lymphoma has the highest incidence between the age of 50 and 60 years [ 5 ], but it was observed that the incidence increased significantly in patients older than 40, in conformity with the data collected in the First Affiliated Hospital of Dalian Medical University in a retrospective study from January 1999 to December 2010 [ 6 ].…”

Analysis of the Response Time to Involved-Field Radiotherapy in Primary Gastrointestinal Low-Grade B-Cell Lymphoma

“…Factors known to cause primary GI lymphoma include bacterial infections such as H.pylori and C.jejuni, preexisting intestinal diseases, and immunosuppression [4]. In the case of gastric lymphoma infected with H.pylori, H.pylori eradication (HPE) consisted of proton pump inhibitors, amoxicillin, and clarithromycin is the primary treatment resulting in an e cacy of over 80% [5,6].…”