Clinicopathological Analysis Of Primary Gastrointestinal Malignant Lymphomas: Report Of 36 Cases

Objective:To analyse clinicopathological characteristics of primary gastrointestinal malignant lymphomas(PGML).Methods:Pathologically proved 36 cases of PGML were included in our study,and their clinicopahological characteristics were retrospectively analysed.Results:Of 36 cases with PGML,22 were male and 14 were female,male female ratio was 1.57:1 with median age of 45 years(range:22-78 years).Primary sites distribution in stomach,small intestine,colon were 66.7%,16.7%and 11.1% respectively,with 2 cases of multiple-organ involvement.Most of the patients' symptomatology were abdominal pain,uneasy feeling-abdomen,abdominal mass, gastrointestinal bleeding,bowel obstruction,perforation with or without concomitant features of fever,weight loss,and generalized weakness.The preoperatively diagnostic rate of 43.3%was observed for endoscopic biopsy for lesions in stomach and colon.Preoperative diagnosis of PGML of small intestine is rather difficult.4 cases presented with perforation and 1 case with intestinal intussuception were found. Diagnosis was possible after emergency surgical interventions.Histologically,B-cell type 86.1%,T-cell type 11.1%,with a case of NK/T cell type were found.According to WHO classification,MALT-type extranodal marginal zone B cell lymphoma 52.8%,diffuse large B cell lymphoma(DLBCL)30.6%,peripheral T cell lymphoma (PTL-U)8.32%,with each case of relatively rare B cell mantle cell lymphoma(MCL), Enteropathy associated T-cell lymphoma(EATL),NK/T cell lymphoma were found in our series.Staging was carried out according to Ann Arbor & Musshoff modified staging for lymphoma,andâ… _E 27.8%,â…¡_E 33.3%,â…¢_E 22.2%,â…£_E 16.7%had been found.16.7%of patients underwent surgery alone,66.7%of patients received surgery in combination with adjuvant chemotherapy and 16.7%of patients received chemotherapy with curative intent of 4-9 cycles.Of 25 patients with follow-up of 4-40 months,9 patients had already died with median overall survival of 7 months. Till date,16 patients are still alive.Conclusions:The data on clinicopathological features of PGML patients is sparse. Endoscopic biopsy or postoperative pathological specimens with IHC play important role in diagnosis.Endoscopic examination and CT scanning are proved to be helpful in diagnosing PGML patients by providing anatomical relation to adjacent structures and multiple involvement.The main pathological hierarchy observed is B-cell type (MALT,DCBCL),T-cell and NK/T cell lymphoma,though the latter is aggressive with bad outcome.Treatment can be based upon factors like site,histological type and clinical staging.