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Tingyu H, Jianqiang L, Zuguang X, Xiujiang Y, Ke C. Value of staging information provided by linear-array endoscopic ultrasound for therapeutic response and prognosis prediction in gastric lymphoma. Dig Endosc 2021; 33:929-938. [PMID: 33124105 DOI: 10.1111/den.13884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Currently, positron emission tomography/computed tomography (PET/CT)-based Ann Arbor and Lugano staging systems are widely applied for gastric lymphoma, which majorly focused on the extent of systemic invasion, but there is insufficient assessment in extent of gastric wall invasion. Thus, we aimed to assess the value of linear-array EUS in therapeutic response and prognosis prediction, and provide an endoscopic ultrasound (EUS)-based staging system for gastric lymphoma. METHODS Between January 2012 and October 2019, 191 patients with histologically confirmed gastric lymphoma were included. We analyzed patients' clinicopathologic data, white-light appearance, EUS staging, tumor extension, and therapeutic regime to identify the predictors for complete remission (CR) and progression-free survival (PFS). RESULTS With a median follow-up period of 547 days, 136 patients achieved CR. Multivariate regression analysis identified EUS T stage three CR predictors, including T stage (T2-T4 vs. T1, OR = 0.271, 95% confidence interval (CI) = 0.108-0.683, P = 0.0085) was the independent predictor. The Ki67 index, lesion surface, EUS stage, tumor extension, and regime predicted PFS, but tumor extension was the only independent predictor (local vs. system, OR = 6.005, 95%CI = 2.365-15.236, P < 0.001). The concordance index (C-index) was higher for CR rate in the EUS-based staging [0.673; 95% CI = 0.628-0.718] than Lugano staging [0.663; 95% CI 0.616-0.710], and for PFS in the EUS-based staging [0.694; 95% CI 0.586-0.802] than Lugano staging [0.684; 95% CI 0.564-0.804]. CONCLUSIONS An EUS-based staging system is suitable for CR and PFS prediction in gastric lymphoma, with highly informative assessment in extent of gastric wall invasion.
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Affiliation(s)
- Hu Tingyu
- Departments of, Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of, Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Liu Jianqiang
- Departments of, Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of, Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xia Zuguang
- Department of, Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Xiujiang
- Departments of, Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of, Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chen Ke
- Departments of, Endoscopy, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of, Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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2
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Sharma KD, Massey AV, Vijayvargiya M, Jain S. A case of multiple recurrent intussusceptions due to multiple lymphomatous polyposis associated with diffuse large B-cell lymphoma of gastrointestinal tract in a 15-year-old child: A rare case report. Int J Surg Case Rep 2020; 79:44-48. [PMID: 33422851 PMCID: PMC7808902 DOI: 10.1016/j.ijscr.2020.12.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 02/07/2023] Open
Abstract
Association of Multiple lymphomatous polyposis with Diffuse Large B-cell Lymphoma. Rare presentation of Multiple intussusceptions due to large Multiple Lymphomatous Polyposis. Primary gastrointestinal (GI) lymphoma clinical presentation, diagnosis and treatment. Review of literature on Multiple lymphomatous polyposis and Primary GI Lymphoma.
Introduction and Importance Multiple lymphomatous polyposis (MLP) is a distinctive and rare entity of primary gastrointestinal (GI) lymphoma characterized by polypoid lymphomatous tissue in long segments of the gut and a strong tendency for spread throughout the GI tract. Although many cases of MLP presenting as intussusceptions in adults have been reported, we report a rare case of multiple recurrent intussusceptions due to MLP associated with high-grade Diffuse Large B-cell lymphoma (DLBCL) of the entire GI tract in a 15-year-old child. Case presentation A 15-year-old child previously operated for acute intestinal obstruction, presented with intermittent abdominal pain, nausea and vomiting. Imaging studies confirmed the diagnosis of multiple small bowel intussusceptions. Patient was treated by exploratory laparotomy and multiple resection anastomosis. Histopathology confirmed the diagnosis of MLP due to DLBCL. The patient received chemotherapy following surgery. So far, at 6 months of follow-up, Patient is doing well. Clinical discussion Malignant tumors of the small intestine are unusual, with non-specific clinical presentation. Although ultrasound (US), CT, FDG-PET/CT and endoscopic evaluation are essential modalities for the diagnosis of intestinal polyposis. Final diagnosis of MLP can only be confirmed after histopathological examination and immunohistochemistry studies. Surgical resection followed by appropriate chemotherapy is the treatment of choice. Conclusions MLP due to DLBCL has rarely been described in young patients under the age of 18 years. We should keep a high index of suspicion for malignant GI lymphoma in cases of intussusception, especially in older children.
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Affiliation(s)
- Kapil Dev Sharma
- Department of Gastrointestinal and Hepatobiliary Surgery, CK Birla RBH Hospital, Jaipur, Rajasthan, India
| | - Ashish V Massey
- Department of Gastrointestinal and Hepatobiliary Surgery, CK Birla RBH Hospital, Jaipur, Rajasthan, India
| | | | - Sundeep Jain
- Department of Gastrointestinal and Hepatobiliary Surgery, CK Birla RBH Hospital, Jaipur, Rajasthan, India.
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3
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Yin X, Xu A, Fan F, Huang Z, Cheng Q, Zhang L, Sun C, Hu Y. Incidence and Mortality Trends and Risk Prediction Nomogram for Extranodal Diffuse Large B-Cell Lymphoma: An Analysis of the Surveillance, Epidemiology, and End Results Database. Front Oncol 2019; 9:1198. [PMID: 31781500 PMCID: PMC6861389 DOI: 10.3389/fonc.2019.01198] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background: DLBCL is the most commonly occurring type of non-Hodgkin's lymphoma, which may be found at various extranodal sites. But little is known about the particular trends of extranodal DLBCL. Methods: A total of 15,882 extranodal DLBCL patients were included in incidence analysis from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2015). The joinpoint regression software was used to calculate the annual percent change (APC) in rates. Nomograms were established by R software to predict overall survival (OS). Results: The extranodal DLBCL incidence continued to rise at a rate of 1.6% (95% CI, 0.4-2.8, p < 0.001) per year over the study period, until it declined around 2003. The incidence-based mortality trend of extranodal DLBCL had a similar pattern, with a decrease happening around 1993. Five-year survival rates improved dramatically from the 1970s to 2010s (44.15 vs. 63.7%), and the most obvious increase occurred in DLBCL patients with primary site in the head/neck. The C-index showed a value for OS of 0.708, which validated the nomograms performed well and were able to forecast the prognosis of patients with extranodal DLBCL. The calibration curves showed satisfactory consistency between true values and predicted values for 1-, 5-, and 10-year overall survival, respectively. Conclusions: The incidence and incidence-based mortality of extranodal DLBCL had been increasing for decades, followed by a promising downward trend in recent years. These findings may help scientists identify disease-related risk factors and better manage the disease. The prediction signature cloud identifies high-risk patients who should receive effective therapies to prevent the fatal nature of this disease, and low-risk patients to reduce over-treatment.
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Affiliation(s)
- Xuejiao Yin
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Aoshuang Xu
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Fengjuan Fan
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenli Huang
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qianwen Cheng
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Zhang
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Sun
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.,Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
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4
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Pawar VB, Surude R, Sonthalia N, Jain S, Contractor Q, Rathi P. An unusual case of obstructive jaundice: ampullary Burkitt lymphoma. J Gastrointest Oncol 2019; 10:379-383. [PMID: 31032110 PMCID: PMC6465488 DOI: 10.21037/jgo.2018.07.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/23/2018] [Indexed: 11/02/2023] Open
Abstract
Primary lymphomas of the digestive tract are uncommon heterogenous group of neoplasms that primarily affects stomach. Lymphomatous involvement of small intestine is amongst the rare lymphomas; ampullary involvement is even rarer. It is important to recognize this entity early as it mimics periampullary neoplasms and its management is different. We present the case of a 14-year-old male who presented with rapidly progressive obstructive jaundice and weight loss and ultimately was diagnosed to have ampullary Burkitt's lymphoma. Early diagnosis of this aggressive tumor and prompt induction of chemotherapy dramatically improved the patient's condition. It is crucial to consider Burkitt's lymphoma as a differential diagnosis of obstructive jaundice as both the treatment and prognosis are markedly different.
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Affiliation(s)
- Vinay Balasaheb Pawar
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Ravindra Surude
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Nikhil Sonthalia
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Samit Jain
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Qais Contractor
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair and TNMC Mumbai, Mumbai, Maharashtra, India
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5
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The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma. Gastroenterol Res Pract 2017; 2017:2397430. [PMID: 28400819 PMCID: PMC5376472 DOI: 10.1155/2017/2397430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/22/2017] [Indexed: 12/26/2022] Open
Abstract
Endoscopic ultrasound (EUS) is considered a valuable diagnostic tool during the workup of malignant gastric lesions, including primary gastric lymphomas (PGL). Although endoscopy combined with multiple biopsies remains essential in the establishment of PGL diagnosis, EUS utilization in locoregional disease staging has been well documented in the literature. Data also support the possible role of EUS in prediction of response to first-line treatment, that is, Helicobacter pylori eradication. However, its application in the posttreatment setting remains problematic, since concordance rates between endosonography and histology findings during follow-up seem to vary substantially. The aim of the present review is to summarize all available data regarding the role of EUS in the management of PGL.
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6
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Staging of Primary Abdominal Lymphomas: Comparison of Whole-Body MRI with Diffusion-Weighted Imaging and (18)F-FDG-PET/CT. Gastroenterol Res Pract 2015; 2015:104794. [PMID: 26798331 PMCID: PMC4700158 DOI: 10.1155/2015/104794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/22/2015] [Accepted: 08/23/2015] [Indexed: 12/13/2022] Open
Abstract
Background. The purpose of this study was to compare the accuracy of whole-body MRI with diffusion-weighted sequences (WB-DW-MRI) with that of 18F-FDG-PET/CT in the staging of patients with primary gastrointestinal lymphoma. Methods. This retrospective study involved 17 untreated patients with primary abdominal gastrointestinal lymphoma. All patients underwent 18F-FDG-PET/CT and WB-DW-MRI. Histopathology findings or at least 6 months of clinical and radiological follow-up was the gold standard. The Musshoff-modified Ann Arbor system was used for staging, and diagnostic accuracy was evaluated on a per-node basis. Results. WB-DW-MRI exhibited 100% sensitivity, 96.3% specificity, and 96.1% and 100% positive and negative predictive values (PPV and NPV), respectively. The sensitivity, specificity, and PPV and NPV of PET/CT were 95.9%, 100%, and 100% and 96.4%, respectively. There were no statistically significant differences between the two techniques (p = 0.05). The weighted kappa agreement statistics with a 95% confidence interval were 0.97 (0.95–0.99) between the two MRI readers and 0.87 (0.82–0.92) between the two methods. Conclusions. WB-DW-MRI appears to have a comparable diagnostic value to 18F-FDG-PET/CT in staging patients with gastrointestinal lymphoma.
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7
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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8
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Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, Chiarenza A, Raimondo CD, Giulietti G, Bonanno G, Palumbo GA, Raimondo FD. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up. World J Gastroenterol 2014; 20:12993-13005. [PMID: 25278693 PMCID: PMC4177478 DOI: 10.3748/wjg.v20.i36.12993] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.
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MESH Headings
- Animals
- Endoscopy, Gastrointestinal
- Endosonography
- Helicobacter Infections/complications
- Helicobacter Infections/microbiology
- Helicobacter pylori/pathogenicity
- Humans
- Intestinal Neoplasms/diagnostic imaging
- Intestinal Neoplasms/microbiology
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm Grading
- Predictive Value of Tests
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
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9
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Vetro C, Chiarenza A, Romano A, Amico I, Calafiore V, Di Raimondo C, Coppolino F, Di Raimondo F. Prognostic assessment and treatment of primary gastric lymphomas: how endoscopic ultrasonography can help in tailoring patient management. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:179-85. [PMID: 24369919 DOI: 10.1016/j.clml.2013.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 12/18/2022]
Abstract
Endoscopic ultrasonography (EUS) has recently gained a pivotal role in the management of gastric lymphomas, especially in the diagnostic workup. Its accuracy and reliability have overcome those of other imaging techniques, such that it represents an invaluable tool for the management of gastric lymphomas. Although this technique is operator dependent, its application in large series has proved its reliability. Thus, it has generally been considered a useful tool for providing information crucial in deciding the treatment program, especially for mucosa-associated lymphoid tissue (MALT) lymphomas, for which EUS can provide an accurate evaluation of disease extension and treatment response probability. Limited-stage disease, confined to the submucosa, has a greater probability to respond to sole Helicobacter pylori eradication. In contrast, the value of EUS in response assessment and follow-up monitoring is still debated, with discordant opinions about its reliability and clinical advantages, because normalization of the EUS findings occurs with a considerable delay compared to the histologic evaluation. In the follow-up setting, preliminary data have indicated that persistently positive EUS findings in low-grade gastric lymphoma could represent a warning for a possible relapse. However, in high-grade gastric lymphoma, such findings do not have any clinical implications.
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Affiliation(s)
- Calogero Vetro
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Annalisa Chiarenza
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Irene Amico
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Valeria Calafiore
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
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10
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Saber MM, Zeeneldin AA, Samra MA, Farag SA. Primary gastrointestinal lymphoma in an Egyptian district: a study using a population-based cancer registry. J Egypt Natl Canc Inst 2013; 25:95-101. [PMID: 23719408 DOI: 10.1016/j.jnci.2013.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/16/2013] [Accepted: 03/17/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Gastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin's lymphoma (NHL) with geographical and age variation of its various subtypes. AIM To study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival. METHODS This is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC). RESULTS GIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47 years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14 months (95% CI, 13.2-48.7 and 6.4-21.6 months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes. CONCLUSIONS GILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.
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Affiliation(s)
- Magdy M Saber
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
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11
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Sotoudehmanesh R, Mirzaagha F, Kolahdoozan S. Role of Endoscopic Ultrasonography in Patients With Thickened Wall Stomach by CT Scan. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479312475088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The usefulness of endoscopic ultrasonography (EUS) in patients who have gastric wall thickening in computed tomography (CT) is not clear. All patients referred for EUS due to thickened gastric folds on CT were included in this study. Esophagogastroduodenoscopy (EGD) followed by EUS was performed on all patients. Twenty-eight patients were enrolled in the study. The mean ± SD age was 50.8 ± 15.9 years, and 60.7% were male. Most patients (78.6%) had symptoms, and 10 patients (35.7%) were ultimately diagnosed with a gastric neoplasm. In all patients with a normal EGD (11 patients), the EUS was normal. Accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of EUS for detecting a lesion in thickened wall stomach on CT were 89.3%, 88.8%, 90.0%, 81.8%, and 94.1%, respectively. In patients with a thickened gastric wall by CT, upper gastrointestinal endoscopy should be done before endoscopic ultrasonography, with ultrasonography reserved for those patients with an abnormal EGD. Endoscopic ultrasonography has good sensitivity for lesion detection in cases with an abnormal endoscopy, and the presence of gastric symptoms increases the likelihood of abnormal EUS.
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Affiliation(s)
- Rasoul Sotoudehmanesh
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroozandeh Mirzaagha
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Kolahdoozan
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
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12
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Vetro C, Romano A, Chiarenza A, Conticello C, Donnarumma D, Gorgone A, Coppolino F, Palumbo GA, Bonanno G, Di Raimondo F. Endoscopic ultrasonography in gastric lymphomas: appraisal on reliability in long-term follow-up. Hematol Oncol 2011; 30:180-5. [PMID: 22189677 DOI: 10.1002/hon.1022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/15/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022]
Abstract
The reliability of endoscopic ultrasonography (EUS) in follow-up management of gastric lymphomas has not been clearly validated. We conducted a retrospective analysis on 23 patients, 12 affected by mucosa-associated lymphoid tissue (MALT) lymphoma, eight by diffuse large B-cell lymphoma, and three by high-grade lymphoma with low-grade component, all treated with a stomach-conservative approach. One hundred and twenty matched evaluations with both EUS and endoscopy with biopsy (E-Bx) were performed, according to validated guidelines and clinical judgment. At a median follow-up of 87 months ranged between 9.5 and 166 months, the analysis of progression-free survival and disease-free survival showed a strict relationship between the persistence of EUS abnormalities and the clinical outcome in patients with MALT lymphoma (p = 0.0079; p = 0.02) but not in patients with high-grade lymphoma. In conclusion, EUS evaluation does not seem reliable in follow-up management of high-grade lymphomas, although it could have a great clinical impact in the management of MALT lymphoma.
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Affiliation(s)
- Calogero Vetro
- Division of Hematology, University of Catania, Ospedale Ferrarotto, A.O. Policlinico-Vittorio Emanuele, Catania, Italy.
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13
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Huang XM, Gao Q. Clinicopathological features and treatment of primary small intestinal lymphoma: recent advances. Shijie Huaren Xiaohua Zazhi 2011; 19:2947-2952. [DOI: 10.11569/wcjd.v19.i28.2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary small intestinal lymphoma (PSIL) is an extra-nodal lymphoma whose clinical and histological presentations are usually heterogeneous depending on the site of the lesion. Proper staging criteria are important for clinicopathological diagnosis. Although there is no consensus regarding the role of surgery and chemotherapy in the treatment of PSIL, surgery followed by chemotherapy and radiotherapy is still the main treatment. This review summarizes the clinicopathological features, diagnosis, therapy and prognosis of PSIL.
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Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011; 17:697-707. [PMID: 21390139 PMCID: PMC3042647 DOI: 10.3748/wjg.v17.i6.697] [Citation(s) in RCA: 249] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract is the most common extranodal site involved by lymphoma with the majority being non-Hodgkin type. Although lymphoma can involve any part of the gastrointestinal tract, the most frequent sites in order of its occurrence are the stomach followed by small intestine and ileocecal region. Gastrointestinal tract lymphoma is usually secondary to the widespread nodal diseases and primary gastrointestinal tract lymphoma is relatively rare. Gastrointestinal lymphomas are usually not clinically specific and indistinguishable from other benign and malignant conditions. Diffuse large B-cell lymphoma is the most common pathological type of gastrointestinal lymphoma in essentially all sites of the gastrointestinal tract, although recently the frequency of other forms has also increased in certain regions of the world. Although some radiological features such as bulky lymph nodes and maintenance of fat plane are more suggestive of lymphoma, they are not specific, thus mandating histopathological analysis for its definitive diagnosis. There has been a tremendous leap in the diagnosis, staging and management of gastrointestinal lymphoma in the last two decades attributed to a better insight into its etiology and molecular aspect as well as the knowledge about its critical signaling pathways.
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Fischbach W, Al-Taie O. Staging role of EUS. Best Pract Res Clin Gastroenterol 2010; 24:13-7. [PMID: 20206104 DOI: 10.1016/j.bpg.2009.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 01/31/2023]
Abstract
Type of lymphoma and stage of disease are the two decisive prognostic factors and therapeutic determinants. For the locoregional staging, i.e. assessment of the gastric wall infiltration and perigastric lymphonodular involvement, endoscopic ultrasound (EUS) is highly useful. EUS has, therefore, to be integrated into the standard staging procedure of gastric lymphoma, although its impact on initial treatment decisions might be limited in the individual case. A benefit from the use of miniechoendoscopes, EUS elastography and EUS-guided biopsies has not yet been proven in gastric lymphoma. EUS also confers an important prognostic value regarding treatment responses to Helicobacter pylori eradication. On the contrary, EUS cannot be recommended as a regular part of follow-up investigations considering its limited value in predicting the response of the lymphoma to radiation or chemotherapy.
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Affiliation(s)
- W Fischbach
- Medizinische Klinik II und Klinik für Palliativmedizin, Klinikum Aschaffenburg, Akademisches Lehrkrankenhaus der Universität Würzburg, Germany.
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The impact of EUS in primary gastric lymphoma. Best Pract Res Clin Gastroenterol 2009; 23:671-8. [PMID: 19744632 DOI: 10.1016/j.bpg.2009.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 05/26/2009] [Indexed: 01/31/2023]
Abstract
Gastric lymphoma is the most frequent site of gastrointestinal lymphoma and is accessible for endosonographic evaluation. Most primary gastric lymphomas are classified as mucosa-associated lymphoid tissue (MALT)-type lymphomas that develop in the course of chronic Helicobacter pylori infection. Endoscopic ultrasonography (EUS) is regarded to be the most accurate method for the local staging of gastric lymphoma, although scientific evidence is limited. In stage uEI1 low-grade lymphoma, EUS is able to predict a high chance for cure by H. pylori eradication. The significance of EUS elastography or EUS-guided fine-needle aspiration biopsy to diagnose nodal involvement has not been investigated in prospective series yet. Since high-grade lymphoma is always treated as a systemic disease, the impact of endosonographic staging is lower than in low-grade lymphoma. After treatment of primary gastric lymphoma, EUS produces conflicting results that are not as accurate as endoscopy with biopsy. Therefore, EUS is not mandatory during follow-up.
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Andriani A, Miedico A, Tedeschi L, Patti C, Di Raimondo F, Leone M, Schinocca L, Romanelli A, Bonanno G, Linea C, Giustini M, Hassan C, Cottone M, Zullo A. Management and long-term follow-up of early stage H. pylori-associated gastric MALT-lymphoma in clinical practice: an Italian, multicentre study. Dig Liver Dis 2009; 41:467-73. [PMID: 18945654 DOI: 10.1016/j.dld.2008.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 09/05/2008] [Accepted: 09/08/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Data on management and long-term follow-up of Helicobacter pylori-associated MALT-lymphoma in clinical practice are scanty. We evaluate the long-term efficacy of H. pylori eradication on low-grade MALT-lymphoma, and the efficacy of further therapies in refractory patients. METHODS This study enrolled patients with stages I-II(1) MALT-lymphoma and H. pylori infection. H. pylori eradication was attempted in all patients. Patients with lymphoma persistence or progression following H. pylori treatments received further lymphoma treatments. Both 5-year and disease-free survivals were calculated. RESULTS Sixty patients (stage I/II(1): 50/10) were followed up for a median time of 65 months (range 7-156). H. pylori infection was successfully eradicated in 53 (88.3%) patients following three consecutive therapeutic attempts, and lymphoma regressed in 42 (79.2%) of these patients. Sixteen patients received anti-neoplastic treatments due to either lymphoma persistence or progression, and lymphoma was cured in 14 (87.5%) cases. At follow-up, lymphoma relapsed in 13/42 (30.9%) patients within a median time of 19 months (range 3-41), and all but 1 patient were cured with further therapies. Overall, lymphoma regression was achieved in 56 patients (93.3%). The 5-year and disease-free survivals were 94.7% and 74.6%, respectively. CONCLUSIONS In clinical practice, a conservative approach with antibiotic eradication seems to be appropriate management for early-stage MALT-lymphoma, with oncologic therapy being reserved for those patients who fail to respond to H. pylori therapy.
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Affiliation(s)
- A Andriani
- Haematology and Gastroenterology Department, San Giacomo Hospital, Rome, Italy.
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Abstract
Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.
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Affiliation(s)
- Natalie G Coburn
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD, Davila RE, Dominitz JA, Harrison ME, Ikenberry SO, Lichtenstein D, Qureshi W, Shen B, Zuckerman M, Fanelli RD, Lee KK, Van Guilder T. Role of EUS. Gastrointest Endosc 2007; 66:425-34. [PMID: 17643438 DOI: 10.1016/j.gie.2007.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wang N, Fu Q, Wang YJ. Advances on the treatment of gastric mucosa-associated lymphoid tissue lymphoma. Shijie Huaren Xiaohua Zazhi 2007; 15:860-868. [DOI: 10.11569/wcjd.v15.i8.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphomas are rare in the gut, and its occurrence rate was 1% to 5% of the malignant tumors. In histological type, most of them are non-Hodgin's lymphomas, while Hodgin's lymphomas are seldom seen. There have been a lot of controversies on the optimal treatments of gastric MALT lymphomas for a long time. Surgery was traditionally considered as the most important approach to cure the disease. However, anti-H. pylori therapy has been regarded as an alternative method since H. pylori infection was found to be relevant with the pathogenesis of gastric MALT lymphomas. In this article, we reviewed the current status and recent advances on the treatment of this disease.
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