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October 2001. Review Article.
Primary gastric lymphoma is an uncommon malignancy that is increasing in incidence and represents approximately 2% to 7% of primary gastric malignancies.
Primary gastric lymphoma is defined as an extranodal lymphoma arising in the stomach and is the most common site of extranodal lymphoma. PGC can spread to regional lymph nodes and become disseminated.
Staging of gastric lymphoma based upon the Ann Arbor system includes stage I E, which is disease limited to the stomach without nodal spread. Stage II E 1 is tumor in the stomach with spread to adjacent contiguous lymph nodes. Stage II E 2 is tumor in the stomach with spread to lymph nodes that are non contiguous with the primary tumor.
Mucosal surfaces along the gastrointestinal tract are usually devoid of lymphatic tissue, except for specific locations, such as Peyer's patches in the ileum. MALT is the lymphatic tissue found in the mucosa, usually acquired after inflammatory reactions or autoimmune processes, that triggers the influx of lymphocytes to the site. The presence of MALT can be regarded as an advanced chronic inflammatory process, wich is benign by its nature. But the presence of lymphatic tissue may give rise to lymphoproliferative processes, namely lymphoma of the non-Hodgkin type. It is believed that ongoing antigenic stimulation is the reason for the transformation from a benign inflammatory process to low-grade lymphoma, and subsequently, to high-grade lymphoma.
Over the last two decades the increasing significance of H pylri in gastric pathology has been recognized. While it was originally found to be associated with peptic ulcer disease, it was subsequently found to play an important role in promoting other gastric pathologies: chronic gastritis, gastric MALT, MALT lymphoma and even gastric adenocarcinoma.It is not yet completely clear how H pylori triggers the gastric processes ( 3 ).
1) J Stephens and J Smith. Treatment of primary gastric lymphoma and gastric mucosa-associated tissue lymphoma. J Am Coll Surg 1998; vol 187, n 3, 312-320.
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