Gastrointestinal Invasion Hematological System Tumors:Clinical Features And Endoscopic Characteristic

Objective:To investigate the clinical and endoscopic features of gastrointestinal infiltrates in hematologic malignancies by analyzing the general,clinical and endoscopic manifestations of primary gastrointestinal lymphoma(PGIL),extramedullary gastrointestinal plasmacytoma(EGIP),and leukemic gastrointestinal infiltrates.Methods:From July 2010 to October 2019,we retrospectively collected 2 cases of PGIL,EGIP,and 2 cases of gastrointestinal infiltration of leukemia in our hospital after endoscopy.We also searched cpvip,Wanfang data and China National Knowledge,and Pub Med from January 2000 to October 2019.There were some literatures about EGIP published at home and abroad.The general condition,clinical manifestation,endoscopic characteristics,etc.,were analyzed and summarized.Results:1.140 cases of PGIL were included in this study.111 cases of primary gastric lymphoma(PGL)were more than 29 cases of primary intestinal lymphoma(PIL).The onset age of PGL group was earlier than that of PIL group(t=-2.307,P=0.024).Abdominal pain is characteristic performance of PGIL,which is asymptomatic in some patients.The PGL group was prevalent in the gastric body and antrum,mainly diffuse large B-cell tumor(DLBCL)and gastric mucosa-associated lymphoid tissue lymphoma(MALT).Gastric MALT lymphoma is predominantly erosive and ulcerative.Other types of gastric lymphoma are endoscopically predominantly ulcerated.There was no significant difference between gastric MALT lymphoma group and non-MALT group in the detection of Hp infection(χ~2=3.316,P=0.069).In the PIL group,DLBCL was predominant in the terminal ileum and ileocecal region,and mass type was common under endoscopy,and MALT lymphoma was rare.Multi-level involvement of bowel lesions may be present.2.55 cases of EGIP were included in this study.Extramedullary plasmacytoma(EMGP)in 32 patients,the clinical manifestations of EMGP included abdominal pain in 11 cases(11/32)and asymptomatic physical examination in 6 cases(6/32).EMGP mainly affects gastric body,EGIP endoscopic mass,polyp,ulcerative.The results of Hp test were recorded in 9 cases,3 cases were positive(33.3%)and 6 cases were negative(66.7%).And extramedullary plasmacytoma(EMIP)in 23 patients.EMIP is prevalent in the small intestine and is uncommon in the large intestine,and mass lesions are predominant.3.Leukemic gastrointestinal infiltration:Gastrointestinal hemorrhage is the main clinical manifestation.Endoscopy may show ulceration,or may be diffuse,forming large cord-like folds,or even a mass.Leukemia may infiltrate any part of the GI tract.Gastrointestinal infiltrates can occur even after complete remission of leukemia.Conclusion:1.PGIL is prevalent in the stomach,and the onset of PGL is earlier than that of PIL.DLBCL and MALT lymphoma were predominant in PGL,erosive and ulcerative in gastric MALT lymphoma,and ulcerative in other PGL.In PIL,DLBCL is predominant,mass type is predominant,and MALT lymphoma is rare.A few PGIL can affect multiple digestive sites at the same time.2.EGIP is prevalent in the stomach.EMGP is prevalent in the gastric body and is often found in mass,ulceration and polyp.EMIP is prevalent in the small intestine,rarely in the large intestine,and mass lesions are predominant.3.Leukemias may infiltrate any part of the digestive tract.Gastrointestinal infiltrates can occur even after complete remission of leukemia.4.Lesions in multiple parts of the gastrointestinal tract should exclude hematologic malignancies.