Primary Gastrointestinal Lymphomas in Adults: An Institutional Experience of 15 Years from Northern India

Abstract

Introduction: Primary Gastrointestinal Lymphomas (PGIL) are uncommon and distinct Gastrointestinal Tract (GIT) malignancies which vary in their epidemiologic and clinicopathologic features worldwide. Since gastrointestinal malignancies are commonest malignancies in Kashmir valley, we intended to study PGIL in our hospital set up. Aim: To study the clinicopathological and demographic profile of PGIL Materials and Methods: This combined retrospective (eight and a half years) and prospective (six and a half years) descriptive observational study of 15 years was performed at Sher-i-Kashmir Institute of Medical Sciences, Srinagar from April 1998 to March 2013. Total 93 cases were included as per Dawson’s criteria. All the cases were reviewed and reclassified according to the World Health Organisation (WHO)-Revised European American Classification of Lymphoid Neoplasms (REAL). Statistical analysis was done using GraphPad Prism 8. Results: Ninety-three patients (Male:Female ratio, 3:1) with a mean age of 47 years (age range=18-70 years) were studied. Patients mostly presented with non specific symptoms like abdominal pain (n=79) and anorexia (n=45); and small intestine (n=30), stomach (n=27) and large intestine (n=26) were the major sites affected. Histopathological and Immunohistochemical (IHC) studies revealed most of them to be Non Hodgkin’s Lymphoma (NHL) of B-cell type (n=89) with Diffuse Large B-Cell Lymphoma (DLBCL), the commonest subtype (n=66) followed by Mucosa Associated Lymphoid Tissue (MALT) lymphoma (n=21). Stage distribution included 64 stage IE, 27 stage IIE and two stage IIIE patients. Surgical resection was performed in 53 patients along with chemotherapy (25), chemoradiotherapy (20) and anti-Helicobacter pylori (anti-H. pylori) treatment (2). Forty patients received chemotherapy without surgery, along with anti-H.pylori treatment (14) and radiotherapy (7). Mean survival of patients was 42 months. Conclusion: Primary Gastrointestinal Lymphomas (PGIL), although uncommon GIT malignancy, can clinically mimic any GIT disease and can involve any part of GIT. A high degree of suspicion can pick up these lymphomas early and a judicial combination of surgery, chemotherapy and radiotherapy can be offered for better survival. Further, IHC studies including genetic and molecular studies along with long term follow-up studies, are required to have a better understanding of these lymphomas in our region.

Keywords

• diffuse large b-cell lymphoma
• helicobacter pylori
• mucosa associated lymphoid tissue lymphoma
• non hodgkin’s lymphoma