GASTROINTESTINAL LYMPHOMAS
Συγγραφέας Γεώργιος Σαμέλης Γράφτηκε στις ,
Gastrointestinal lymphomas typically present with non-specific signs and symptoms attributable to the site of involvement. In a study of 371 patients registered in the German multicenter study GIT NITL 01/12, the following sites were involved: stomach (75%), small bowel (9%), ileo-cecal region (7%), more than one GI site (7%), rectum (2%), and diffuse colonic involvement (1%).
The most prominent symptoms, independent of site of disease, include abdominal pain, loss of appetite, loss of weight, vomiting and night sweats. Other symptoms (e.g. bleeding, diarrhea, constipation, ileus) varied according to disease site.
Diagnostic Evaluation: The diagnosis of lymphoma is based on upper endoscopy, colonoscopy, small bowel contrast radiography, barium enema and on biopsies (depending on the site of involvement).
The Staging Evaluation: All patients should undergo computerized tomography of the abdomen, pelvis and chest to look for evidence of locoregional lymph node involvement, infiltration of contagious structures and distant metastases.
Gastric Lymphoma accounts for 3% of gastric neoplasms and 10% of lymphomas. It can arise from a) gastric muscular areas (now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL classification) and section on extranodal marginal zone B-cell lymphoma of MALT, b) secondary involvement via spread from adjacent lymph nodes.
Conditions that predispose to gastric lymphomas are: helicobacter pyloro-associated chronic gastritis, autoimmune diseases, immunodeficiency syndromes (AIDS), long standing immunosuppressive therapy (post transplant).
Intestinal Lymphoma: It accounts for 75% of primary gastrointestinal lymphomas in the Middle East and Mediterranean area, and depends upon its association with immuno-proliferative small intestinal disease (IPSID).
Mantle Cell Lymphoma: it can involve the stomach, small intestine or colon. The involvement of multiple sites, particularly the small intestine and colon is referred as “lymphomatous polyposes”. The mean age at presentation is 55 years with a male predominance.
Burkitt’s and Burkitt like Lymphomas: Endemic Burkitt’s lymphoma is a disease of childhood with a peak incidence at about 8 years of age. “Burkitt’s like” (sporadic Burkitt’s) lymphoma exhibits an under age distribution with only 50% of cases affecting children. It often presents with abdominal pain and obstructive symptoms caused by ileo-cecal involvement.
Enteropathy Associated T-Cell Lymphoma (EALT): It is a sequel of gluten-sensitive enteropathy (Celiac sprue) ulcerative enteritis another complication of long standing celiac sprue, is probably a variant of EALT. The mean age of patients with EALT is 60 years old. When endoscopy is non-diagnostic laparotomy may be necessary to confirm the diagnosis.
Endoscopic view of the rectum in a 95 year old patient who presented with weight loss and anemia. The biopsy revealed non Hodgkin’s lymphoma
Colonoscopic view of multiple polypoid lesions in the proximal colon. Histology was consistent with a mantle cell lymphoma.
