| Objective:The present study was conducted to analyze the clinical cases and review the literature, to understand the pathogenesis, clinical characteristics, endoscopic features, pathological types and individual therapy of primary gastrointestinal malignant lymphoma(PGIML), and investigate the prognostic factors, to improve the level of the diagnosis and treatment for clinicians.Methods:We collected 48 cases of PGIML of the first hospital of Lanzhou University, which were diagnosed through endoscopic and surgical biopsy from January 2010 to November 2015. Date were recorded by Excel and analyzed by SPSS software.Results:A total of 48 eligible cases diagnosed with PGIML were collected in this study. The 48 cases consisted of 31 males and 17 females, The male: female ratio was 1.82:1. The age ranged from 3 to 78 years with a median of 51 years, most of cases distributed in the area from 41 to 60 years old. Of the 48 cases, 24 cases were gastric lymphomas as well as intestinal lymphomas, with a median of 54 and 49 years respectively. No significant difference was noted among the age between gastric and intestinal lymphomas. Location of tumor:In gastric lymphoma cases, the most originated in the body of stomach(18.7%), followed by sinus(10.4%). In intestinal lymphoma cases, the most originated in the ileocecus(20.8%), followed by jejunum(14.5%)and ileum(6.3%). Clinical characteristics:The course ranged from 0.1 to 48 months, the median were 2.0 months and 1.3 months respectively, with no significant difference between gastric and intestinal lymphomas. The size of gastric lymphomas ranged from 0.5cm to 14 cm, and that of intestinal lymphomas ranged from 2cm to 20 cm, the median were 3cm and 7cm respectively with significant difference. In total, the most common initial clinical characteristics were abdominal pain(66.7%), weight loss(39.6%), abdominal distention(35.4%), abdominal mass(25.0%), obstruction(20.8%), melena(14.6%). Laboratory tests:There were 21 cases of anemia, 23 cases of positive fecal occult blood, 15 cases of abnormal LDH, 2 cases of abnormal CA724. Hp test:Of 8 cases, 5 cases were positive, including 3 cases of MALT lymphoma and 2 cases of DLBCL. To gastric and intestinal lymphoma, the diagnostic rate of CT were 5.3% and 10.5% respectively, that of single endoscopy were 16.7% and 0, that of endoscopy and biopsy were 75% and 100%. Some cases misdiagnosed as gastric cancer, peptic ulcer, gastritis, gastric polyp, colonic cancer and carcinoma of small intestine by endoscopy. Pathological types:30 cases were DLBCL(62.5%), 10 cases were MALT lymphoma(20.7%), 3 cases were Burkitt lymphoma(6.3%), 1 case was PTCL(2.1%) and 1 case was EATL(2.1%). Clinical staging:According to Lugano staging, Stageâ… included 10 cases, Stage â…¡included 19 cases, Stage â…¡E included 6 cases and Stage â…£ included 13 cases. To gastric and intestinal lymphomas, the rate of Stage â… and Stage â…¡were 83.3% and 37.5% respectively with significant difference. Therapy choice:24 patients received surgery-based multiple therapy, 15 patients underwent surgery alone, 5 patients accepted chemotherapy alone, 2 patients received Hp eradication, and no one accepted radiation therapy alone. Prognosis:To gastric and intestinal lymphoma, 1-year survival rate were 83.3% and 50%, 3-year survival rate were 63.3% and 42.1%. There was significant difference between gastric and intestinal lymphoma in 1-year survival rate. Clinical staging and LDH were prognostic factors of PGIML in this study.Conclusion:The prevalence of PGIML was higher in male and middle-old age group. The most common sites of gastric lymphoma were the body and sinus of stomach, that of intestinal lymphoma were ileocecus and jejunum. The size of intestinal lymphoma was bigger than gastric lymphoma, the symptoms were non-specific. The rate of Hp test was low, so as the diagnostic rate of CT and single endoscopy, endoscopy and biopsy could increase the diagnostic rate. DLBCL was the most frequent subtype. MALT originating in gastric lymphoma was more frequent than intestinal lymphoma. The most clinical stages were Stage â… and Stage â…¡ in gastric lymphoma. The most common treatment choice was surgery-based multiple therapy. 1-year survival rate of gastric lymphoma was higher than intestinal lymphoma, Clinical staging and LDH were prognostic factors of PGIML in this study. |
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