Malignant Diseases of the Stomach Gastric Lymphoma

■ Clinical Aspects

Gastric lymphoma may be a primary extranodal lesion, or a generalized, primary nodal lymphoma may infiltrate the gastric mucosa secondarily. Primary gastric lymphoma arises from mu-cosa-associated lymphoid tissue (MALT).

Chronic H. pylori infection plays a major role in the patho-genesis of MALT lymphomas. Gastric lymphoma has a considerably better prognosis than gastric carcinoma, with a reported five-year survival rate of 50-90 %.

Differential diagnosis

Gastric carcinoma

Gastritis

Checklist for endoscopic evaluation

Description of morphological features

Location

Endoscopic diagnostic criteria (Figs. 3.111, 3.113)

► No typical features. In some cases the mucosa appears almost normal, in others it appears gastritic with patchy erythema and a bumpy surface.

► Ulcerations: superficial or deep, with or without raised edges, multiple, bizarre

► Polypoid growth is sometimes seen.

► Location: ubiquitous, with a predilection for the gastric body and antrum

Fig. 3.112 Endosonographic image of a high-grade non-Hodgkin lymphoma of the stomach

Fig. 3.111 Gastric lymphomas a High-grade non-Hodgkin lymphoma of the stomach

Fig. 3.111 Gastric lymphomas a High-grade non-Hodgkin lymphoma of the stomach

c Ulcerated gastric lymphoma

b MALT lymphoma of the stomach

d MALT lymphoma of the stomach

Additional Studies

To plan treatment that is appropriate for the stage of the disease, it is necessary to localize ("map") the findings in the stomach and look for additional manifestations.

- Eight to ten biopsies from the gross lesion

- Systematic biopsies from grossly normal-appearing mucosa Antrum: four biopsies (one per quadrant)

Body: four biopsies (one per quadrant)

Fundus: two biopsies

- Ear, nose, and throat (ENT) examination

- Differential blood count

- Bone-marrow aspiration

- Chest radiograph

- Thoracic CT

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