Gastrointestinal Lymphoma in Tertiary Gastroenterology Center: Epidemiological, Clinical and Endoscopic Features

Abstract

Introduction. Within the heterogeneous group of extra-nodal lymphoma, the gastrointestinal tract is the most frequently involved extranodal site accounting for 30-50% of all extranodal cases. Gastrointestinal involvement most oftenoccurs secondarily, while the primary gastrointestinal lymphomasare relatively rare accounting for 30%-45% of all extranodal lymphomas and 0.9% of all gastrointestinal tumors. Within the gastrointestinal tract, lymphoma can arise in any region but the stomach is the most commonly involved organ being affected in 50-70% of all the gastrointestinal lymphomas, followed by the small intestine and ileocecal region. The aim of the study was to analyze and present data regarding the endoscopic aspects and clinical presentation of patients with gastrointestinal lymphoma. Methods. We retrospectively reviewed the medical records of patients with primary or secondary gastrointestinal lymphoma diagnosed at our Clinic over a fifteen-year period (January 1, 1999 to December 31, 2013). We analyzed the demographic data, clinical presentation, anatomic distribution, endoscopic aspect of the lesion, extension of the neoplastic process and occurrence of different histological subtypes. Results. We discovered 18 patients with gastrointestinal lymphoma (7 males and 11 females). Fourteen patients (77.7%) were considered primary, while 4 patients (22.2%) were considered secondary gastrointestinal lymphoma. The stomach was affected in 14 cases (11 primary and 3 secondary), there were 2 duodenal lymphomas, 1 lymphoma of the terminal ileum and 1 peritoneal lymphoma. In most patients (10) massive and diffuse gastrointestinal infiltration was diagnosed, 5 patients had ulcerated lesions in the stomach and 3 patients presented with polyploid mass. Six patients presented with upper gastrointestinal bleeding, 1 patient with biliary tract obstruction, one patient with protein losing enteropathy, malabsorption and consecutive bowel perforation and one patient presented only with ascites and pleural effusion. All the malignant lymphomas were Non-Hodgkin type and among them we registered only one T-cell lymphoma. Being diagnosed in 6 patients (33.33%), diffuse large B-cell lymphoma was the most prevalent histological type. The lymphoma was limited to the gastrointestinal tract in 6 patients, 7 patients had regional nodal involvement, in 2 patients there was an intra-abdominal spread and in 3 patients there was an extra-abdominal dissemination. Most patients received chemotherapy and only 2 patients were treated surgically. Two patients had rapidly progressive clinical course and lethal outcome shortly after the diagnosis was established and before chemotherapy was administered. Conclusion. The gastrointestinal lymphoma has a variable clinical presentation and endoscopic aspect that often makes the diagnosis challenging. Substantial level of diagnostic awareness and comprehensive clinical approach are necessary in order to establish the correct diagnosis, provide appropriate treatment and prolong survival.