Primary gastric non-Hodgkin's lymphoma: requirements for diagnosis and staging

Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters

Objective:

Non-Hodgkin’s lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of ¹⁸F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging ¹⁸F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL.

Methods:

Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging ¹⁸F-FDG PET/CT have been performed and quantitative parameters of SUV_max, SUV_mean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL.

Results:

There were statistically significant differences between high-grade and low-grade PGISL in terms of SUV_max, SUV_mean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUV_max, SUV_mean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis.

Conclusion:

Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.

Clinicopathological study of primary gastric lymphomas in the central region of Tunisia, with survival analysis

BACKGROUND

Primary gastric lymphomas (PGL) are rare and represent only 5% of gastric malignancies, but are apparently increasing in incidence worldwide. Optimal treatment of PGL remains controversial. The aim of this study was to evaluate clinicopathological characteristics, prognostic factors, survival rates, and treatment modalities in Tunisian patients with PGL.

METHODS

We retrospectively analyzed data from patients treated for PGL in our hospital over an 18-year period (1994-2011).

RESULTS

Data from 128 patients with PGL were retrospectively analyzed. Eighty-four were males and the median age was 57 years (range 5-89 years). The mean BMI was 22.9 (15-39). A total of 40 patients (31.2%) had a poor performance status (PS). The antrum was the most commonly involved site (52 cases, 40.6%). The most frequent pathological subtypes were diffuse large-cell lymphomas (46.4%) and mucosa-associated lymphoid tissues (32%). Disease was localized (stages IE and IIE) in 97 patients (75.8%). Ninety-six patients were evaluable. Chemotherapy alone was used in 73 (76%) patients, with 76.7% achieving complete remission. During chemotherapy, there were no severe complications requiring urgent surgery. Actuarial five-year overall and event-free survival were 60.2 and 54.3% respectively. We found no statistically significant difference in survival between patients treated with surgery and those treated by a conservative strategy. In the multivariate study, age greater than 60 years, poor PS, and BMI less than 20 were significant prognostic factors for overall survival (P=0.04, 0.009, and <0.001, respectively).

CONCLUSION

Surgery provides no advantage for survival over conservative treatment. Age, PS, and BMI were effective prognostic factors.

Primary giant lymphoma of the right thigh: A case report and brief review of the literature

Primary soft tissue non-Hodgkin lymphoma (NHL) of the extremities is very rare. The clinical features of NHL mimic those of other soft tissue tumors, particularly sarcoma; however, they should be differentiated, as the treatment and prognosis are completely different. In this study, the case of a 68-year-old female with a giant mass, movement disorder, numbness and painful sensations in the right thigh is presented. Magnetic resonance (MR) imaging revealed a huge circle-shaped mass. Fine needle aspiration cytology (FNAC) of the tumor demonstrated neoplastic small, round cells. The tentative diagnosis was of a mesenchymal sarcoma. The right thigh was amputated. On histological examination of the amputated extremity, the diagnosis was found to be large B cell lymphoma. Primary soft tissue NHL of the extremities is a systemic malignant disease and is sensitive to chemo-therapy and radiotherapy. The histological diagnosis should be identified as far as possible before the tumor is widely excised.

The Evolution in the Management of Gastric Lymphoma

The management of gastric lymphoma is a rapidly changing field. The classification and staging of lymphomas have been revised in the past two decades, reflecting diagnostic advances that include the use of immunohistochemical stains and cell-surface markers. Furthermore, the use of CT scanning and endoscopic ultrasound has revolutionized the non-operative diagnostic modalities available. Despite these advances, the future of gastric lymphoma research lies in the development of therapeutic regimens.

Imaging of gastrointestinal lymphoma

The gastrointestinal (GI) tract contains the largest collection of lymphocytes anywhere in the body. GI lymphoma may arise at any site in the GI tract but typically involves the stomach and small bowel in cases of systemic disease. Most cases are non-Hodgkin B-cell type. Enteropathy-associated T cell lymphoma can complicate celiac disease. Less commonly, lymphoma may originate in the GI tract without systemic involvement. This sometimes occurs in response to chronic infections. This article discusses the role of imaging in detecting and staging GI tract lymphomas, using fluoroscopy and cross-sectional imaging, primarily CT.

Review of endoscopic ultrasound-guided fine-needle aspiration cytology

This review, based on the Hennepin County Medical Center experience and review of the literature, vastly covers the up-to-date role of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (FNA) in evaluating tumorous lesions of the gastrointestinal tract and adjacent organs. Emphasis is given to the tumoral and nodal staging of esophageal, pulmonary, and pancreatic cancer. This review also discusses technical, pathological, and gastroenterologic aspects and the role of the pathologist and endosonographer in the evaluation of these lesions, as well as the corresponding FNA cytology and differential diagnosis.

Lymphomatous involvement of gastrointestinal tract: evaluation by positron emission tomography with (18)F-fluorodeoxyglucose

AIM

To demonstrate the (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) findings in patients with non-Hodgkinos lymphoma (NHL) involving the gastrointestinal (GI) tract and the clinical utility of modality despite of the known normal uptake of FDG in the GI tract.

METHODS

Thirty-three patients with biopsy-proven gastrointestinal NHL who had undergone FDG-PET scan were included. All the patients were injected with 10-15 mCi FDG and scanned approximately 60 min later with a CTI/Siemens HR (+) PET scanner. PET scans were reviewed and the maximum standard uptake value (SUV(max)) of the lesions was measured before and after the treatment, if data were available and compared with histologic diagnoses.

RESULTS

Twenty-five patients had a high-grade lymphoma and eight had a low-grade lymphoma. The stomach was the most common site of the involvement (20 patients). In high-grade lymphoma, PET showed focal nodular or diffuse hypermetabolic activity. The average SUV(max)+/-SD was 11.58+/-5.83. After the therapy, the patients whose biopsies showed no evidence of lymphoma had a lower uptake without focal lesions. The SUV(max)+/-SD decreased from 11.58+/-5.83 to 2.21+/-0.78. In patients whose post-treatment biopsies showed lymphoma, the SUV(max)+/-SD was 9.42+/-6.27. Low-grade follicular lymphomas of the colon and stomach showed diffuse hypermetabolic activity in the bowel wall (SUV(max) 8.2 and 10.3, respectively). The SUV(max) was 2.02-3.8 (mean 3.02) in the stomach lesions of patients with MALT lymphoma. ONCLUSION: (18)F-FDG PET contributes to the diagnosis of high-grade gastrointestinal non-Hodgkin's lymphoma, even when there is the normal background FDG activity. Furthermore, the SUV plays a role in evaluating treatment response. Low-grade NHL demonstrates FDG uptake but at a lesser intensity than seen in high-grade NHL.

Les lymphomes gastriques du MALT

INTRODUCTION

The stomach is the most common site involved in primary gastrointestinal lymphoma. Gastric lymphoma originates from the mucosa-associated lymphoïd tissue so called MALT. It comprises a group of distinctive clinicopathological entities which are important to consider for clinical management.

CURRENT KNOWLEDGE AND KEY POINTS

In recent years, new diagnostic tools and new treatment strategies have improved the overall prognosis. One of the most exciting recent discoveries is the hypothesis that an infection by a bacterium, Helicobacter pylori has a decisive role in gastric lymphoma.

FUTURE PROSPECTS AND PROJECTS

Recent advances, essentially due to molecular biology and cytogenetic studies may emerge with the understanding of pathogenesis and new prognostic factors of these different types of gastric lymphomas. It is the aim of our oncoming studies together with the evaluation of the new therapeutic options such as radiotherapy and monoclonal antibodies in prospective studies.