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Review
. 2019 Sep 13;6(1):e000320.
doi: 10.1136/bmjgast-2019-000320. eCollection 2019.

Gastrointestinal lymphoma: the new mimic

Anusha Shirwaikar Thomas  1 , Mary Schwartz  2 , Eamonn Quigley  2
Affiliations
Review

Gastrointestinal lymphoma: the new mimic

Anusha Shirwaikar Thomas et al. BMJ Open Gastroenterol. .

Abstract

Background: Gastrointestinal (GI) lymphomas comprise a group of distinct clinicopathological entities of B- or T- cell type, with primary gastrointestinal Hodgkin lymphoma being extremely uncommon. The GI tract is the predominant site of extranodal non-Hodgkin lymphoma accounting for 30-40% of all extranodal lymphomas. In the Western world, the stomach is the most commonly involved site followed by the small bowel. Several chronic inflammatory and immune-mediated disorders which predispose to accelerated cell turnover may lead to the malignant transformation of gut lymphocytes and ultimately manifest as GI lymphoma. The challenge for the clinical gastroenterologist is that these tumors may have varied presentations, ranging from nonspecific symptoms such as dyspepsia or bloating to abdominal pain, nausea, vomiting, GI bleeding, diarrhea, weight loss or bowel obstruction.

Objective: We illustrate the range of presentations of GI lymphoma with examples based on consecutive cases evaluated at our institution over a 6-month period. These cases demonstrate how appropriately directed endoscopic evaluation with biopsies has the potential to provide a definitive diagnosis and allow the patient to proceed to definitive therapy.

Conclusions: The GI tract is the most commonly involved site for extranodal lymphoma with the stomach being most frequently involved organ. Chronic Helicobacter pylori infection, celiac disease, inflammatory bowel disease and autoimmune disorders may predispose to GI lymphoma. This heterogenous group of diseases has varied presentations that may mimic several other GI clinico-pathologic entities. GI lymphomas may be diagnosed with appropriately directed endoscopic evaluation coupled with generous tissue sampling and expert pathologic assessment. Management may range from antibiotic therapy, in the case of Helicobacter pylori-associated gastric MALT lymphoma, to chemotherapy with or without radiation and, in rare instances, surgery. There are presently no guidelines to direct endoscopic surveillance of GI lymphomas following treatment.

Keywords: gastric lymphoma; gastrointestinal neoplasia; gastrointestinal pathology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Partially obstructing mass at ileocecal valve. (B) High grade B cell lymphoma
Figure 2
Figure 2
(A) Multilobulated ulcerated polypoid lesion at the ileocaecal valve. (B) A large fungating, polypoid, ulcerated, non-obstructing mass in the distal ileum
Figure 3
Figure 3
(A) A caecal mass with adjacent lymphadenopathy on contrasted abdominal imaging. (B) Malignant appearing partially obstructing cecal tumor. (C) EBV positive Burkitt Lymphoma.
Figure 4
Figure 4
Benign appearing colon polyps.
Figure 5
Figure 5
(A) Large cratered necrotic duodenal ulcer. (B) Marked duodenal wall thickening on contrasted abdominal imaging. (C) Large B- cell lymphoma.
Figure 6
Figure 6
(A) Mass in the gastric fundus on contrasted abdominal imaging. (B) Large, fungating, infiltrative mass in fundus. (C) Diffuse large B cell lymphoma.
Figure 7
Figure 7
Non specific gastric erosions and duodenal bulb erythema.
Figure 8
Figure 8
(A) Large gastric mass with direct invasion into left lobe of liver on contrasted abdominal imaging. (B) Fungating, ulcerated mass in gastric body. (C) Diffuse large B cell lymphoma.
Figure 9
Figure 9
(A, B) Clean based antral and duodenal bulb ulcers. (C) MALT lymphoma.
See this image and copyright information in PMC

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