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Primary Gastric Lymphoma: Clinical Insights

Primary gastric lymphoma is a rare diagnosis that is usually made through histological examination rather than suspected endoscopically. This study reviewed 36 cases of primary gastric lymphoma diagnosed between 2006-2019. Abdominal pain was the most common symptom, reported in 77.78% of patients. Endoscopically, 66.6% of patients showed ulcerations, most described as deep with raised edges. The antrum was the most common site of involvement. Repeated biopsies were often needed, with a mean delay of 22.4 days to diagnosis for patients requiring a second biopsy. Diffuse large B cell lymphoma was the most common histological subtype identified.

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Sandeep Narayanan
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9 views3 pages

Primary Gastric Lymphoma: Clinical Insights

Primary gastric lymphoma is a rare diagnosis that is usually made through histological examination rather than suspected endoscopically. This study reviewed 36 cases of primary gastric lymphoma diagnosed between 2006-2019. Abdominal pain was the most common symptom, reported in 77.78% of patients. Endoscopically, 66.6% of patients showed ulcerations, most described as deep with raised edges. The antrum was the most common site of involvement. Repeated biopsies were often needed, with a mean delay of 22.4 days to diagnosis for patients requiring a second biopsy. Diffuse large B cell lymphoma was the most common histological subtype identified.

Uploaded by

Sandeep Narayanan
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© All Rights Reserved
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Clinical and Endoscopic Profile of Primary Gastric

Lymphoma

Category :Hemato-oncology
Title : Clinical and Endoscopic Profile of Primary Gastric
Lymphoma
Authors : Dr Sandeep Narayanan1,Dr Rathan Cyriac2
Affiliations: 1
Senior Resident,Gastroenterology,Govt Medical
College,Kannur ,2Assistant Professor, Gastroenterology,Govt Medical
College,Kannur

Introduction/ Aims & Objectives :


Primary Gastric lymphoma is a rare endoscopic diagnosis. It is seldom
suspected and is almost always a histological diagnosis. The aim of our study
was to study the clinical and endoscopic features of primary gastric lymphoma.

Materials & Methods:


This is a retrospective study from 2006 to 2019. Patient’s data were obtained
from institutional records. Endoscopic images were obtained from endoscopy
image library.

Results :
A total of 36 cases of Primary Gastric Lymphoma were identified from the
records. There were 24 males and 12 female patients. Mean age of presentation
was 49.2 years.

Abdominal pain was the most common symptom(77.78%). 25 % of the patients


had B symptoms. 52 % of patients with abdominal pain had nocturnal
symptoms.33 % of the patients had vomiting. 16.67 % of patients had history of
GI Bleed.
Endoscopically 66.6% patients had ulcerations, 25 % patients had
polypoid/elevated lesions. The rest had diffuse infiltration/thickening. Antrum
was the most common site of involvement followed by body of stomach. Most
of the ulcers (90%) were described as deep ulcers with raised edges. Beaded
edges were described only in 12 % of the ulcers. Undermining of edges was
described only in 2 cases. Gastric outlet obstruction was present in 4 % of the
cases.

32 % of the patients had to undergo repeat biopsy before a final diagnosis was
made. The mean delay in diagnosis in patients who had a repeat biopsy was
22.4 days. On histopathology diffuse large B cell lymphoma was the most
common(66%) followed by Malt Lymphoma (24%) and Follicular Lymphoma
(6%).

Discussion & Conclusion:


Primary Gastric Lymphoma is a rare endoscopic diagnosis. Abdominal pain is
the most common presentation. Endoscopic picture is almost indistinguishable
from carcinoma stomach. Deep ulcers without beaded edges may suggest
lymphoma. Repeated biopsy is the key for early diagnosis if endoscopic picture
is consistent.
Figures

Symptoms
Mass 0.05%

Weight Loss 27.70%

B Symptoms 25.00%

Dysphagia 0.05%

GI Bleed 16.67%

Vomiting 33.30%

Abdominal Pain 77.78%

Endoscopic findings
80.00%
70.00%
60.00%
50.00%
40.00%
66.67%
30.00%
20.00%
10.00% 19.40%
11.10%
0.00% 0.02%
Ulcers Raised lesions/Polyp Diffuse lesions Others

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