Gastric Lymphoma

• • 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

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