Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years?

Abstract

Summary Primary gastric (PG) lymphomas are generally non‐Hodgkin lymphomas (NHL). They represent 5% of gastric malignancies and show an apparently increasing incidence worldwide. The most common histological subtypes are diffuse large B‐cell and marginal zone B‐cell NHL of the mucosa‐associated lymphoid tissue (MALT)‐type. Pathogenesis is often related to Helicobacter pylori infection (HPI). There is still no consensus on the optimal treatment for PG lymphoma. Nowadays surgery is limited to rare cases and radiotherapy – combined or not with chemotherapy – represents an effective therapeutic option ensuring long‐term, organ‐salvage benefits mainly in aggressive histological subtypes. Additionally, the description of MALT lymphomas has made the situation even more complex, because antibiotics alone can induce lasting remissions in those cases associated with HPI. Consequently, a global therapeutic approach to the cure of PG‐NHL has completely changed over the last 10 years: innovative, conservative options to reduce treatment toxicity, thus preventing systemic relapses, have made their appearance and are on the rise.

Gastric Perforation: Unusual Presentation of Gastric Lymphoma in Pediatric Population

“…Gastro-intestinal hemorrhage (hematemesis or melena) occurs at the outset in 20-30% of patients, while gastric occlusion and perforation are quite uncommon [6].…”

Gastric lymphoma

“…3 Gastric lymphoma accounts for 3%-5% of all malignant tumors of the stomach. 4 Although the incidence of gastric carcinoma has been reduced. The incidence of primary gastric lymphoma is increasing.…”

“…Although surgery has been used as its initial treatment, recent studies showed that radiotherapy alone can achieve a complete remission with a 5-year disease free period. 4 Thus, "involved-field" irradiation at the total dose of 30 Gy for over 4 weeks has become the treatment of choice for stages I and II MALT lymphoma without H. pylori or with persistent lymphoma following therapy.…”

“…Recent studies have demonstrated that anti-H. Pylori therapy can achieve the remission of indolent lymphoma, H. pylori negative MALT lymphoma and DLBCL. 4,20 …”

Early-Stage Gastric MALT Lymphoma: Is It a Truly Localized Disease?

“…Fifty-nine patients had stage I (95%) and three patients had stage II 1 disease according to the modified Blackledge staging system [14,15]. There were 36 men and 26 women, with a median age of 57 years (range, .…”