Gastrointestinal (GI) lymphomas
40% of the lymphomas are extra- nodal and Gastrointestinal (GUT) tract is the more common site.
1 to 4% malignancies of GUT are lymphomas.
Definition: Primary GI lymphoma shows no evidence of liver, spleen, or bone marrow at the time of diagnosis (regional lymph nodes may be involved).
GI lymphomas are seen in certain population like:
- Patients with helicobacter gastritis.
- Natives of mediterranean people.
- Patients with congenital immune deficiency.
- HIV- infected individuals.
- Patients with immunosuppressive therapy.
- Patient with sprue disease.
- This is termed as Western type lymphoma .
- This arises from B – lymphocytes, mucosa associated lymphoid tissue (MALT).
- These differ from nodal lymphoma:
- Usually there is local disease, which may be resectable.
- There may be relapse.
- Genotype is different and unique 11:18 has been found in MALT (Translocation).
G I Lymphoma
Age : Usually affect adults.
Sex: There is no predilection.
Site: There is involvement of :
- stomach = 55 to 60%
- Small intestine = 25 to 30%
- Proximal colon = 10 to 15%
- Distal colon = upto 10%
- Appendix and esophagus = Rare.
H.Pylori Role: This bacteria produces cytokines which activates T-Helper cells and it leads to monoclonal proliferation of B- lymphocytes.
- Antibiotics treatment may cause regression of the tumor.
Sprue associated Lymphoma the tumor in stomach.
- This will arise in some patients with long standing malabsorption syndrome.
- This is common in the younger age group 30 to 40 years of age.
- Most often seen in the proximal small intestine.
- This may be T – lymphocyte origin in response to gluten derived antigen.
- Overall prognosis is poor.
- This is unusual intestinal B- lymphocyte lymphoma in patient with mediterranean ancestry.
- There is background of chronic diffuse mucosal plasmacytosis.
- This plasmacytosis produces abnormal IgA – heavy chain (V- portion deleted).
- There is history of malabsorption and now called as immunoproliferative small intestinal disease (IPSID)>
- There is response to antibiotics.