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  • • Epigastric pain and weight loss

    • Contrast radiographic or upper GI endoscopic evidence of gastric mass

    • Endoscopic biopsy provides diagnosis

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Epidemiology

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  • Gastric lymphoma

    • -Second most common primary cancer of the stomach, representing 2% of the total number

      -Most common site of extranodal lymphoma

      -Almost all are non-Hodgkin lymphomas, generally classified as B cell mucosa-associated lymphoid tissue (MALT) lymphomas

      -Subclassified as low- or high-grade based on nuclear pattern

      -20% of patients manifest a second primary cancer in another organ

      -Associated with chronic Helicobacter pylori infection

    Gastric pseudolymphoma

    • -Consists of a mass of lymphoid tissue in the gastric wall often associated with an overlying mucosal ulcer

      -Represents response to chronic inflammation and is not malignant

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Symptoms and Signs

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  • • The principal symptoms are epigastric pain and weight loss

    • Nausea and vomiting

    • Occult GI hemorrhage

    • Characteristically, the tumor has attained bulky proportions by the time it is discovered and a palpable epigastric mass is present in 50% of patients

    • Pseudolymphoma presents similarly with pain and weight loss

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Laboratory Findings

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  • • Associated with H pylori infection

    • Anemia

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Imaging Findings

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  • Barium x-ray studies will demonstrate the lesion

    Gastroscopy with biopsy and brush cytology provides the correct diagnosis preoperatively in about 75% of cases

    CT scan and bone marrow biopsy for preoperative staging

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  • • Epigastric pain and weight loss should prompt upper GI endoscopy, which will reveal the lesion

    • Endoscopic biopsy is diagnostic

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Rule Out

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  • • Gastric adenocarcinoma

    • Benign gastric ulcer

    • Gastric lymphoma in the case of pseudolymphoma

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  • • Upper GI contrast study will reveal the lesion

    • Gastroscopy with biopsy and brush cytology will be diagnostic in most cases; endoscopic US may increase the diagnostic yield

    • Preoperative staging

    • -CT scan

      -Bone marrow biopsy

      -Biopsy of any enlarged peripheral lymph nodes

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When to Admit

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  • • Inability to tolerate enteral nutrition

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  • Lymphoma: Surgical resection and staging followed by total abdominal radiotherapy

    Pseudolymphoma: Resection; no additional therapy

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Surgery

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Indications

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  • • Splenectomy should be performed only if the spleen is directly invaded

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Contraindications

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  • • Extension into the duodenum or esophagus should not lead to resection of these organs but to postoperative adjunctive therapy

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Medications

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  • • Adjuvant radiation and chemotherapy for stage II and higher

    • Eradication of H pylori for low-grade MALT

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Complications

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  • • Occult GI bleeding

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Prognosis

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  • • 5-year disease-free survival, 50%; correlates with stage, grade, and extent of penetration of the gastric wall

    • 60% of recurrences are extra-abdominal

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Prevention

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  • • Eradication of H pylori...

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