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relating to or involving the stomach; "gastric ulcer" (同)stomachic, stomachal
a neoplasm of lymph tissue that is usually malignant; one of the four major types of cancer

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胃の,胃に発生する

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/07/07 23:27:28」(JST)

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Endoscopic image of gastric MALT lymphoma taken in body of stomach in patient who presented with upper GI hemorrhage. Appearance is similar to gastric ulcer with adherent blood clot.

Primary gastric lymphoma (lymphoma that originates in the stomach itself)^[1] is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. However, the stomach is a very common extranodal site for lymphomas (lymphomas originating somewhere else with metastasis to stomach).^[2] It is also the most common source of lymphomas in the gastrointestinal tract.^[3]

Signs and symptoms

Most of the people primary gastric lymphoma affects are over 60 years old.^[4] Symptoms include epigastric pain, early satiety, fatigue and weight loss.

Risk factors

Risk factors for gastric lymphoma include the following:

Helicobacter pylori^[5]
Long-term immunosuppressant drug therapy
HIV infection

Diagnosis

These lymphomas are difficult to differentiate from gastric adenocarcinoma. The lesions are usually ulcers with a ragged, thickened mucosal pattern on contrast radiographs.

The diagnosis is typically made by biopsy at the time of endoscopy. Several endoscopic findings have been reported, including solitary ulcers, thickened gastric folds, mass lesions and nodules. As there may be infiltration of the submucosa, larger biopsy forceps, endoscopic ultrasound guided biopsy, endoscopic submucosal resection, or laparotomy may be required to obtain tissue.

Imaging investigations including CT scans or endoscopic ultrasound are useful to stage disease. Hematological parameters are usually checked to assist with staging and to exclude concomitant leukemia. An elevated LDH level may be suggestive of lymphoma.

Pathophysiology

The majority of gastric lymphomas are non-Hodgkin's lymphoma of B-cell origin. These tumors may range from well-differentiated, superficial involvements (MALT) to high-grade, large-cell lymphomas. Sometimes, it's hard to differentiate poorly differentiated high grade B-cell gastric lymphoma from gastric adenocarcinoma clinically or radiologically, yet histopathology with immunohistochemistry is recommended to stain specific markers on the malignant cell that favor the diagnosis of lymphoma. Immunohistochemistry stains specific clusters of differentiation that are present on B-cells like CD20. Cytokeratin is also a surface marker that is presented on epithelial cells, is stained histochemically and favors the diagnosis of epithelial tumors like adenocarcinoma.

Differentiating poor gastric lymphoma from adenocarcinoma is essential because the prognosis and modalities of treatment differ significantly.

Other lymphomas involving the stomach include mantle cell lymphoma and T-cell lymphomas which may be associated with enteropathy; the latter usually occur in the small bowel but have been reported in the stomach.

Treatment

Diffuse large B-cell lymphomas of the stomach are primarily treated with chemotherapy with CHOP (cyclophosphamide+doxorubicine+vincristine+prednisone) with or without rituximab being a usual first choice. Antibiotic treatment to eradicate H. pylori is indicated as first line therapy for MALT lymphomas. About 60% of MALT lymphomas completely regress with eradication therapy.^[6] Radiation treatment for H. pylori negative gastric malt lymphoma, has a high success rate, 90% or better after 5 years. Second line therapy for MALT lymphomas is usually chemotherapy with a single agent, and complete response rates of greater than 70% have been reported.^[7]

Subtotal gastrectomy, with post-operative chemotherapy is undertaken in refractory cases, or in the setting of complications, including gastric outlet obstruction.

References

^ Dawson IM, Cornes JS, Morson BC (July 1961). "Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis". Br J Surg 49: 80–9. doi:10.1002/bjs.18004921319. PMID 13884035.
^ Aisenberg AC (October 1995). "Coherent view of non-Hodgkin's lymphoma". J. Clin. Oncol. 13 (10): 2656–75. PMID 7595720.
^ Koch P, del Valle F, Berdel WE, et al. (September 2001). "Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92". J. Clin. Oncol. 19 (18): 3861–73. PMID 11559724.
^ Thirlby RC (January 1993). "Gastrointestinal lymphoma: a surgical perspective". Oncology (Williston Park, N.Y.) 7 (1): 29–32, 34; discussion 34, 37–8. PMID 8420540.
^ Parsonnet J, Hansen S, Rodriguez L, et al. (May 1994). "Helicobacter pylori infection and gastric lymphoma". N. Engl. J. Med. 330 (18): 1267–71. doi:10.1056/NEJM199405053301803. PMID 8145781.
^ Bayerdörffer E, Neubauer A, Rudolph B, et al. (June 1995). "Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group". Lancet 345 (8965): 1591–4. doi:10.1016/S0140-6736(95)90113-2. PMID 7783535.
^ Hammel P, Haioun C, Chaumette MT, et al. (October 1995). "Efficacy of single-agent chemotherapy in low-grade B-cell mucosa-associated lymphoid tissue lymphoma with prominent gastric expression". J. Clin. Oncol. 13 (10): 2524–9. PMID 7595703.

UpToDate Contents

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1. 原発性消化管リンパ腫の臨床症状および診断 clinical presentation and diagnosis of primary gastrointestinal lymphomas
2. 消化管リンパ腫のマネージメント management of gastrointestinal lymphomas
3. ヘリコバクターピロリ菌感染と消化管悪性腫瘍の関連性 association between helicobacter pylori infection and gastrointestinal malignancy
4. 節外（MALT）および節性濾胞辺縁帯リンパ腫の臨床症状、病理学的特徴、および診断 clinical manifestations pathologic features and diagnosis of extranodal malt and nodal marginal zone lymphomas
5. 辺縁帯（MALT）リンパ腫の治療 treatment of marginal zone malt lymphoma

English Journal

Herpes folliculitis masquerading as cutaneous lymphoma.

Bae-Harboe YS, Bhawan J, Demierre MF, Goldberg LJ.Source*Department of Dermatology; and ‡Section of Dermatopathology, Boston University Medical Center, Boston, MA.
The American Journal of dermatopathology.Am J Dermatopathol.2013 Aug;35(6):663-5. doi: 10.1097/DAD.0b013e318289b084.
: Herpes virus infections presenting as folliculitis are uncommon. We describe a 48-year-old white man with a distant history of a childhood gastric lymphoma and renal cell carcinoma presenting with an itchy eruption. He was concerned about recurrence. A punch biopsy revealed interface dermatitis wi
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Primary Gastric Lymphoma Presenting as Acute Pancreatitis: A Case Report.

Raj M, Ghoshal UC, Choudhuri G, Mohindra S.SourceDepartment of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences. Lucknow, India. mohindrasamir@yahoo.com.
JOP : Journal of the pancreas.JOP.2013 Jul 10;14(4):463-465. doi: 10.6092/1590-8577/1186.
CONTEXT: Diffuse large B-cell lymphoma is the commonest form of non-Hodgkin lymphoma. Gastro-intestinal tract and bone marrow are common extra-nodal sites of lymphomatous involvement.CASE REPORT: A 54-year-old woman presented with acute onset epigastric pain. On evaluation, raised serum amylase and
PMID 23846949

Secondary mucosa-associated lymphoid tissue (MALT) lymphoma of the colon.

Shaheen S, Guddati AK.SourceDepartment of Internal Medicine, Harvard Medical School, Massachusetts General Hospital, Harvard University, 50 Fruit Street, Boston, MA, USA.
Medical oncology (Northwood, London, England).Med Oncol.2013 Jun;30(2):502. doi: 10.1007/s12032-013-0502-2. Epub 2013 Feb 20.
Mucosa-associated lymphoid tissue (MALT)-type lymphomas most commonly occur in the stomach and have been associated with Helicobacter pylori infection. However, MALT-type lymphoma of the colon is a rare entity. It commonly manifests with symptoms of weight loss, low-grade fever, constipation, melena
PMID 23423787

Japanese Journal

The Resolution of <i>Helicobacter suis-</i>associated Gastric Lesions after Eradication Therapy

Internal Medicine 57(2), 203-207, 2018
NAID 130006309242

The Diagnosis of Gastric Mucosa-associated Lymphoid Tissue Lymphoma by Flow Cytometry and Fluorescence <i>in Situ</i> Hybridization of Biopsy Specimens