Regression of gastric high grade mucosa associated lymphoid. Chemotherapy for management of localised highgrade gastric b. High grade gastric lymphomas are generally believed to be helicobacter pylori hpindependent growing tumors. To assess efficacy and toxicity of the most common therapiessurgery followed by chemotherapy or chemotherapy alonewe began a controlled clinical trial in patients in early stage i and ii.
Six were predominantly low grade, 12 were predominantly high grade, and five contained both low and high grade areas. Compared to low grade malt lymphoma, high grade gastric lymphoma is reported to be associated with a lower complete remission rate and shorter survival. Notably, the incidence of gastric adenocarcinoma among individual with gastric malt lymphoma has been reported to be 6fold higher, the risk of developing other nhl seems also high, while the frequency of high grade transformation seems to be low 23,24. Dlbcl, and partly transformed from low to high grade malt and lastly diffuse large b cell lymphoma. Primary gastric lymphoma accounts for 1015 percent of all nhl cases. The bacterial infection induces and sustains an actively proliferating bcell population through direct autoantigen and indirect intratumoral t cells. Some studies suggest a role for trisomy 3 in the genesis of these lymphomas, but they mainly focused on low. Highgrade primary gastric lymphomas are nearly always of the bphenotype and are characterised by an aggressive clinicalpathological. High grade lymphomas of malt are thought to lack these features and can only be identified as malt lymphomas with confidence if they are admixed with residual low grade tumours. Regression of high grade bcell gastric lymphoma after eradication of helicobacter pylori infection. Nov 03, 2018 malt lymphoma of stomach this subtype is more common. It is a low grade less aggressive and slowgrowing tumor. The nccn guidelines panel for cervical cancer screening endorses the following guidelines for the prevention and early detection of cervical cancer. Histological grading in gastric lymphoma gastroenterology.
We studied 23 cases of malt lymphoma of the thyroid. Paradoxically, high grade lymphomas are more readily treated and have better prognoses. Compared to lowgrade malt lymphoma, highgrade gastric lymphoma is reported to be associated with a lower complete remission rate and. High grade bcell gastric lymphoma with complete pathologic. Malt lymphoma of stomach this subtype is more common. An in vitro study by hussell et al 4 showed that tumor cells from high grade gastric lymphoma did not respond to a costimulation of autologous t cells and lysate of a specific hp strain, as low grade gastric malt lymphoma cells did. Primary gastric lymphoma lymphoma that originates in the stomach itself is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. Role of chemotherapy in gastric malt lymphoma, diffuse large bcell lymphoma and other lymphomas.
Overall, males were slightly more prevalent, alarm symptoms were absent in near half of the patients, lymphoma was diagnosed in a stage i in onethird of the patients, and helicobacter. It has been shown that some gastric high grade large bcell lymphomas overexpress the bcl6 protein8 or demonstrate rearrangements of the bcl6 locus on chromosome 3q27. The treatment of localized disease was based on surgery alone, or followed by chemotherapy andor radiotherapy. Diffuse b cell lymphoma, burkitt lymphoma and peripheral t cell lymphoma are all types of high grade nonhodgkin lymphoma nhl. Treatment of highgrade malt mucosaassociated lymphoid tissue gastric lymphoma remains uncertain. High grade nhl nonhodgkin lymphoma cancer research uk. High grade primary gastric lymphomas are nearly always of the bphenotype and are characterised by an aggressive clinicalpathological presentation. Treatment for high grade feline lymphoma usually consists of chemotherapy. Oncology an aggressive lymphoma that responds poorly to chemotherapy and comprises 20% of lymphomas prognosis hgls have a mean survival of lymphoma. Surgery and chemotherapy versus chemotherapy as treatment of. Forty two cases of primary high grade gastric lymphoma that regressed with anti hp treatment were found. Highgrade primary gastric lymphomas are nearly always of the bphenotype and are characterised by an aggressive clinicalpathological presentation. High grade lymphomas include large cell, immunoblastic, lymphoblastic, and small noncleaved cell lymphomas.
The outcome depends on five wellestablished prognostic factors that make up the international prognostic index ipi. High grade aggressive nonhodgkin lymphoma is a fastgrowing disease. Gastric lowgrade malt lymphoma, highgrade malt lymphoma and. These two types of lymphoma vary in behavior so a definitive diagnosis will affect the treatment recommendation. Clinicopathological features of gastric mucosa associated. Primary gastric lymphoma has also been reported to occur more frequently in caucasians than africanamericans. It is also the most common source of lymphomas in the gastrointestinal tract.
Gastric lymphoma represents the most common site of extranodal lymphoma, accounting for 25% of all such lymphomas, 50% of all gastrointestinal lymphomas, but comprise only 15% of all gastric malignancies,8. However a few cases of regression of highgrade gastric lymphomas after the cure of helicobacter pylori infection had been described. Both radiation therapy and chemotherapy are suitable alternative options for h. Treatment usually depends both on the type of lymphoma and the stage extent of the disease, but many other factors can be important as well. This should be followed by detailed staging procedures that include endoscopic ultrasonography eus. Role of helicobacter pylori eradication in high grade malt lymphoma. Pdf diagnosis and treatment of gastric malt lymphoma.
Introduction gastric lymphoma arising from mucosaassociated lymphoid tissue malt was first reported as a low grade gastric lymphoma in 1983 by isaacso1. Gastric lymphoma may either represent secondary involvement by systemic disease or primary malignancy confined to the stomach. Lymphomas may be curable if detected in early stages with modern treatment. Gastric dlbcl is sometimes called high grade gastric lymphoma. Krick, vmd, dacvim oncology university of pennsylvania school of veterinary medicine philadelphia, pa introduction lymphoma is the most common hematopoietic tumor in cats, and the incidence is reportedly the highest for any species. Bacterial colonisation of the gastric mucosa triggers lymphoid infiltration and the formation of acquired malt.
In highgrade malt lymphomas, trisomies were found in 16 of 25 cases 64%, mainly involving chromosomes 12 and 18. Primary gastric lymphoma is the most common form of extranodal nonhodgkin lymphoma nhl, accounting for 3040 percent of all extranodal sites. However a few cases of regression of high grade gastric lymphomas after the cure of. Morgner a, miehlke s, fischbach w, schmitt w, mullerhermelink h, greiner a, thiede c, schetelig j, neubauer a, stolte m, ehninger g, bayerdorffer e complete remission of primary high grade bcell gastric lymphoma after cure of helicobacter pylori infection. Google scholar see all references the term gastric highgrade malt lymphoma that was used for a long time by us and others 3 x 3 greiner, a, muller, kb, hess, j, pfeffer, k, mullerhermelink, hk, and wirth, t. Gastric malt lymphoma is a distinct entity related to helicobacter pylori gastritis. In low grade lymphoma complete remission rate was 92%, and five year survival 75%, in high grade lymphoma results were significantly less favourable p. High grade malt lymphomas have been shown to be associated with p53 abnormalities 9 and overexpression of bcl6. Pdf stomach preservation in low and highgrade primary. Treatment of primary gastric diffuse large bcell lymphoma is still controversial. Gastric lowgrade malt lymphoma, highgrade malt lymphoma. It is a high grade more aggressive and rapidgrowing tumor. Pdf high grade bcell gastric lymphoma with complete. However, the stomach is a very common extranodal site for lymphomas lymphomas originate elsewhere and metastasise to the stomach.
Together, the malt and dlbcl subtypes, account for about 90% of all gastric lymphomas. Here is a description of these prognostic factors and how they affect outcomes. Most primary gastric lymphomas are low grade mucosaassociated lymphoid tissue malt or largecell high grade types. In low grade lymphoma endoscopic findings were often interpreted as a benign condition 27 of 51, in contrast with high grade lymphoma, where carcinoma was most frequently 37 of 63 suspected. The overall 2year survival rates for low grade lymphoma did not differ in the rishadjusted treatment groups, ranging from 89% to 96%, in high grade lymphoma, patients with complete resection or. There were anedoctal cases reported and patients belonging to prospective studies. Genetic aberrations common in gastric highgrade large bcell. Transformation from indolent malttype lymphoma to a more aggressive type highgrade lymphoma has repeatedly been described in the course of the. Most highgrade nhls diagnosed in the uk are bcell lymphomas about 9 in every 10 cases, but some people develop tcell lymphoma. Epitheliotropism in highgrade lymphomas of mucosaassociated. American cancer society, american society for colposcopy and cervical pathology, and american society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Highgrade lymphoma definition of highgrade lymphoma by. One hundred and two patients were randomized to be treated with surgery followed by six cycles of. The approach to the management of gastric lymphoma must begin with a precise pathologic diagnosis based on histologic examination and immunophenotyping, at a minimum.
Yet it responds well to treatment and many patients can be cured. Primary gastric lymphoma pathogenesis and treatment. Does surgery belong to medical history for gastric lymphomas. High grade bcell lymphomas with translocations of myc and bcl2 andor bcl6 doubletriple hit lymphoma high grade bcell lymphomas, nos. Doctors put nhl into 2 groups, depending on how quickly they are likely to grow and spread. The survival probability for low grade malignant lymphomas was significantly better than for tumors with secondary high grade transformation p less than 0. Primary lowgrade and highgrade gastric maltlymphoma prese. Highgrade means the cancer cells are dividing quickly, so highgrade lymphomas are fastgrowing. Pdf primary gastric lymphoma a case report researchgate. Primary gastric lymphoma, epidemiology, clinical diagnosis.
In patients without a malt component, absence of disease dissemination beyond local nodes as judged by clinical staging vide infra served as an indication of a gastric origin of the. Primary gastric lymphoma nord national organization for. A lymphoma that grows and spreads quickly but has a better response to anticancer drugs than that seen with low grade lymphomas. Resultsdata regarding 2000 patients were collected. Malt lymphoma has distinct histological and clinical characteristics. The development of gastric mucosaassociated lymphoid tissue malt lymphoma is dependent on helicobacter pylori infection. Nonhodgkin lymphoma nhl is generally divided into main 2 types, based on whether it starts in b lymphocytes b cells or t lymphocytes t cells. This is an argument for considering longterm endoscopic followup of these patients.