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Gastrointestinal lymphoma: the new mimic
  1. Anusha Shirwaikar Thomas1,
  2. Mary Schwartz2,
  3. Eamonn Quigley2
  1. 1Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Hepatology and Nutrition, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Anusha Shirwaikar Thomas; ASThomas1{at}mdanderson.org

Abstract

Background Gastrointestinal (GI) lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin lymphoma being extremely uncommon. The GI tract is the predominant site of extranodal non-Hodgkin lymphoma accounting for 30–40% of all extranodal lymphomas. In the Western world, the stomach is the most commonly involved site followed by the small bowel. Several chronic inflammatory and immune-mediated disorders which predispose to accelerated cell turnover may lead to the malignant transformation of gut lymphocytes and ultimately manifest as GI lymphoma. The challenge for the clinical gastroenterologist is that these tumors may have varied presentations, ranging from nonspecific symptoms such as dyspepsia or bloating to abdominal pain, nausea, vomiting, GI bleeding, diarrhea, weight loss or bowel obstruction.

Objective We illustrate the range of presentations of GI lymphoma with examples based on consecutive cases evaluated at our institution over a 6-month period. These cases demonstrate how appropriately directed endoscopic evaluation with biopsies has the potential to provide a definitive diagnosis and allow the patient to proceed to definitive therapy.

Conclusions The GI tract is the most commonly involved site for extranodal lymphoma with the stomach being most frequently involved organ.Chronic Helicobacter pylori infection, celiac disease, inflammatory bowel disease and autoimmune disorders may predispose to GI lymphoma. This heterogenous group of diseases has varied presentations that may mimic several other GI clinico-pathologic entities. GI lymphomas may be diagnosed with appropriately directed endoscopic evaluation coupled with generous tissue sampling and expert pathologic assessment. Management may range from antibiotic therapy, in the case of Helicobacter pylori-associated gastric MALT lymphoma, to chemotherapy with or without radiation and, in rare instances, surgery. There are presently no guidelines to direct endoscopic surveillance of GI lymphomas following treatment.

  • gastric lymphoma
  • gastrointestinal neoplasia
  • gastrointestinal pathology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Presented at The material in the paper was previously presented as an abstract at the WCG meeting in Orlando in 2017.

  • Contributors AST and EQ conceived the idea for the study and planned the study. AST collated the clinical and endoscopic data. MS collated and reviewed all pathology. AST drafted the manuscript which EQ and MS edited. All three authors reviewed and approved the final manuscript.

  • Funding This study was supported in part by a bequest to the Lynda K and David M Underwood Center for Digestive Disorders and the Josephine Hughes Sterling Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.

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