Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Epigastric pain and weight loss• Contrast radiographic or upper GI endoscopic evidence of gastric mass• Endoscopic biopsy provides diagnosis +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Laboratory Findings + • Associated with H pylori infection• Anemia +++ Imaging Findings + •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 + • Epigastric pain and weight loss should prompt upper GI endoscopy, which will reveal the lesion• Endoscopic biopsy is diagnostic +++ Rule Out + • Gastric adenocarcinoma• Benign gastric ulcer• Gastric lymphoma in the case of pseudolymphoma + • 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 +++ When to Admit + • Inability to tolerate enteral nutrition + • Lymphoma: Surgical resection and staging followed by total abdominal radiotherapy• Pseudolymphoma: Resection; no additional therapy +++ Surgery +++ Indications + • Splenectomy should be performed only if the spleen is directly invaded +++ Contraindications + • Extension into the duodenum or esophagus should not lead to resection of these organs but to postoperative adjunctive therapy +++ Medications + • Adjuvant radiation and chemotherapy for stage II and higher• Eradication of H pylori for low-grade MALT +++ Complications + • Occult GI bleeding +++ Prognosis + • 5-year disease-free survival, 50%; correlates with stage, grade, and extent of penetration of the gastric wall• 60% of recurrences are extra-abdominal... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth