Annals of Oncology Advance Access originally published online on July 22, 2008
Annals of Oncology 2008 19(12):1992-1999; doi:10.1093/annonc/mdn525
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reviews |
Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management
1 Second Department of Internal Medicine Propaedeutic, Athens University Medical School, University General Hospital ‘Attikon’, Haidari, Greece
2 Department of Internal Medicine, Yale University School of Medicine, New Haven, USA
* Correspondence to: Dr S. Papageorgiou, Second Department of Internal Medicine Propaedeutic, Atttikon General Hospital, 1 Rimini street, 124 62 Haidari, Greece. Tel: +30-210-58-31-663; Fax: +30-210-53-26-454; E-mail: sotirispapageorgiou{at}hotmail.com
Gastrointestinal lymphoma is the most common form of extranodal lymphoma, accounting for 30%–40% of cases. The most commonly involved site is the stomach (60%–75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). Helicobacter pylori infection has been implicated in the pathogenesis of MALT gastric lymphoma, but its role in gastric diffuse large B-cell non-Hodgkin's lymphoma (NHL) is controversial. The therapeutic approach for patients with gastric NHL has been revised over the last 10 years. Conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has replaced gastrectomy as standard therapy in cases with DLBCL. Additionally, MALT lymphomas are mainly treated with antibiotics alone, which can induce lasting remissions in those cases associated with H. pylori infection. Nevertheless, various therapeutic aspects for primary gastric lymphomas are still controversial and several questions remain unanswered. Among others, the role of rituximab, consolidation radiotherapy as well as H. pylori eradication in histological aggressive subtypes warrants better clarification.
Key words: diffuse large B-cell lymphomas, extranodal lymphomas, Helicobacter pylori infection, mucosa-associated lymphoid tissue, primary gastric lymphomas
Received for publication January 25, 2008. Revision received June 17, 2008. Accepted for publication June 20, 2008.