Primary gastrointestinal non-Hodgkin's lymphomas. A retrospective clinicopathologic study of 150 cases

Abstract

The records of 150 primary gastrointestinal (GI) lymphomas in adults collected from 1974 to 1982 at the Department of Pathology, University of Vienna, were reviewed. One hundred thirty‐three cases of malignant lymphomas (ML) were analyzed with respect to histologic type, presenting tumor stage, and clinical course, as well as for factors influencing prognosis. The histologic type of ML as assessed by the Working Formulation and the Kiel, the Lukes and Collins, and the Rappaport classifications showed only a minor influence on prognosis. MLs of follicular center cell origin prevailed in the stomach and large cell, immunoblastic MLs prevailed in the bowel. Immunoperoxidase studies indicated a B‐cell nature of GI MLs and demonstrated intracytoplasmic IgM kappa or lambda in most of the MLs of the small lymphocytic, plasmacytoid, and immunoblastic type, respectively. The 105 cases of gastric MLs represented 3.6% of all malignancies of the stomach collected during the study period. Clinical symptoms preceded the diagnosis by 4.4 months on average, and endoscopic biopsy specimens indicated malignancy in 78%. Presenting tumor stages of gastric MLs according to the Ann Arbor staging system were Stage I in 20%, Stage II in 76.2%, and Stage IV in 3.8%. The 28 cases of intestinal ML localized in the small and large bowel without any site prevalence presented with Stage I in 14%, Stage II in 82%, and Stage III in 4%. Tumor resection was performed in 90% of all cases and was followed by multiagent therapy in 53%. Radical tumor resection was obtained in 58% of the gastric MLs and only 28.6% of the intestinal MLs and was closely related to tumor stage. Statistical analysis demonstrated a significant influence of the presenting tumor stage on prognosis as expressed by the overall 2‐year survival rate of 70% for Stage I versus 39% for Stage II ML. In addition, Stage II1 according to Musshoff et al. run a better course than II2 as shown by the disease‐free 2‐year survival rate of 49% versus 15%, respectively. Radical tumor resection was a major determinant of survival and cure of disease as exhibited by the disease‐free 2‐year survival rate of 57% after radical resection versus 8% after nonradical resection of ML. Finally, diffuse tumor growth and tumor penetration of the gastric wall beyond serosa decreased the survival rates.

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

“…A second malignancy occurred in one case. (Gospodarowicz et al, 1983;Fleming et al, 1982;Paulson et al, 1983;Herrera et al, 1985;Dragosics et al, 1985;Ampil, 1987;Rosenfelt & Rosemberg, 1980;Economopoulos et al, 1985;Sheridan et al, 1985;Liang et al, 1987;Steward et al, 1985;Janus et al, 1984;List et al, 1988;Shepherd et al, 1988). Our study indicates that chemotherapy following surgical resection of gastrointestinal lymphomas is highly effective: we obtained 81% CRs in patients treated with partial or palliative resection, and an overall 76% 10-year causespecific survival, which are results comparable with those of other recently published reports (Paulson et al, 1983;Sheridan et al, 1985;Liang et al, 1987;Janus et al, 1984;List et al, 1988;Shepherd et al, 1988).…”

“…While several studies have emphasised the effectiveness of the complete surgical resection of localised lesions (Siegert et al, 1985;Fleming et al, 1982;Maor et al, 1984;Paulson et al, 1983), the majority of authors consider this therapeutic approach as non-curative. The clinical efficacy of adjuvant postoperative radiotherapy remains controversial (Herrmann et al, 1980;Hande et al, 1978;Gospodarowicz et al, 1983;Siegert et al, 1985;Paulson et al, 1983;Weingrad et al, 1982;Lim et al, 1977;Shimm et al, 1983;Herrera et al, 1985;Dragosics et al, 1985;Rao et al, 1984;Mittal et al, 1983;Ampil, 1987).…”

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

“…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.…”

“…Although localized (stage I and II) primary gastric lymphoma (PGL) has been treated by various modalities, including surgery (Shiu et al, 1982), chemotherapy (Maor et al, 1984: Salles et al, 1991, surgery plus radiotherapy (Shiu et al, 1982;Gospodarowicz et al, 1983;Taal et al, 1993), surgery plus chemotherapy (Paulson et al, 1983;Sheridan et il, 1985;Shepherd et al, 1988;Bellesi et al, 1989;Pasini et al, 1994) and radiotherapy plus chemotherapy (Burgers et al, 1988;Dragosics et al, 1985, Maor et al, 1990Tondini et al, 1993), the best management for this disease is still unclear.…”

Primary Gastrointestinal Non-Hodgkin's Lymphoma:A Population Based Study in Central Finland in 1975–1993

“…In the Western countries gastrointestinal lymphomas comprise less than 20% of all non-Hodgkin's lymphomas ( I ) and less than 5% of all primary gastrointestinal malignancies (2,3), though there are regional and racial variations. Even in cases of uncommon malignancies the distinction of gastrointestinal lymphomas has become more important due to better awareness and increasing frequency of predisposing conditions (4).…”