CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(04): 251-255
DOI: 10.4103/0971-5851.195736
ORIGINAL ARTICLE

Clinicopathological profile of gastrointestinal lymphomas in Kashmir

Mehnaaz Sultan Khuroo
Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
,
Summyia Farooq Khwaja
Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
,
Ajaz Rather
Department of Surgery, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
,
Zhahid Hassan
Department of Endocrinology, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
,
Ruby Reshi
Department of Pathology, Government Medical College, Srinagar, Jammu and Kashmir, India
,
Naira Sultan Khuroo
Dr Khuroo's Medical Clinic, Srinagar, Jammu and Kashmir, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Background: The histological categorization of lymphoma has been a source of controversy for many years for both clinicians and pathologists. Clinicopathologic information of gastrointestinal lymphomas in Indian subcontinent is lacking. We studied histopathological spectrum of Primary Gastrointestinal Lymphomas (PGIL) and attempted to classify the G.I. lymphomas based on the recent WHO classification in to major histological types and immunological categories. Material and Methods: This study was done to evaluate the clinicopathological pattern of 100 cases with a histopathological diagnosis of primary gastrointestinal lymphoma at a tertiary care hospital. All patients of primary gastrointestinal lymphomas were included with the help of medical records over a 11-years period that is, January 2005 to December 2015. Results: The study included 100 cases (60 males, 40 females; mean age 51.43 years; age range 4.5-90 years) . The disease involved stomach in 82 (82%), small intestine in 8 (8%), large bowel and rectum in 8 (8%), gall bladder in 1 (1%) and oesophagus in 1 (1%). 82 (82%) of the 100 cases were Diffuse Large B cell lymphomas; 12 (12%) were Extra Nodal Marginal Zone Lymphomas (ENMZL of MALT type) 2 (2%) IPSID 2 (2%) of Mantle cell lymphoma morphology, 1 (1%) Burkitt's and 1(1%) enteropathy associated T cell lymphoma. The commonest presenting symptom was abdominal pain. 99 (99%) of 100 tumours were classified as B-cell lymphomas immunohistochemically and majority exhibited monoclonal light chain restriction on kappa/lambda staining. In addition; Burkitt's lymphoma showed positivity for CD 10. One tumour (1%) showed positivity for T-cell markers. The data demonstrated that primary GI NHL is more common among males, mainly in their fifth decade. Abdominal pain is the most common presenting symptom, with stomach being the most commonly involved site. Diffuse large cell lymphoma is the most frequent histologic subtype, followed by extranodal marginal-zone B cell lymphoma (MALT type). H. Pylori infection was observed in cases with low grade MALT lymphomas. Striking was the observation of two cases of IPSID (a disease commonly found in Mediterranean countries) and one case of enteropathy associated T cell lymphoma. Conclusion: EGD, imaging, light microscopic examination and immunohistochemical workup for B and T cell markers and staining for light chains to assist documentation of monoclonality are of precise diagnostic value in gastrointestinal lymphomas and form a part of the diagnostic workup.



Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Isaacson PG, Norton AJ. Malignant lymphoma of the gastrointestinal tract. In: Extranodal Lymphomas. Edinburgh: Churchill Livingstone; 1994. p. 15-65.
  • 2 Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, et al. A revised European-American classification of lymphoid neoplasms: A proposal from the international lymphoma study group. Blood 1994;84:1361-92.
  • 3 Jaffe ES, Harris NL, Stein H, Vardiman JW. Tumors of Hematopoietic and Lymphoid Tissues, Pathology and Genetics, World Health Organisation Classification of Tumors. Lyon: IARC Press; 2001.
  • 4 Isaacson PG, Du MQ. Gastrointestinal lymphoma: Where morphology meets molecular biology. J Pathol 2005;205:255-74.
  • 5 Stolte M, Eidt S. Lymphoid follicles in antral mucosa: Immune response to Campylobacter pylori? J Clin Pathol 1989;42:1269-71.
  • 6 Wyatt JI, Rathbone BJ. Immune response of the gastric mucosa to Campylobacter pylori. Scand J Gastroenterol 1988;142:44-9.
  • 7 Hussell T, Isaacson PG, Crabtree JE, Spencer J. The response of cells from low-grade B-cell gastric lymphomas of mucosa-associated lymphoid tissue to Helicobacter pylori. Lancet 1993;342:571-4.
  • 8 Nakamura S, Matsumoto T, Iida M, Yao T, Tsuneyoshi M. Primary gastrointestinal lymphoma in Japan: A clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 2003;97:2462-73.
  • 9 Al-Sayes FM. Gastrointestinal non-Hodgkin's lymphoma: A clinico-pathological study. Saudi J Gastroenterol 2006;12:118-22.
  • 10 Berger F, Coiffier B, Bonneville C, Scoazec JY, Magaud JP, Bryon PA. Gastrointestinal lymphomas. Immunohistologic study of 23 cases. Am J Clin Pathol 1987;88:707-12.
  • 11 Isaacson P, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer 1983;52:1410-6.
  • 12 Herrmann R, Panahon AM, Barcos MP, Walsh D, Stutzman L. Gastrointestinal involvement in non-Hodgkin's lymphoma. Cancer 1980;46:215-22.
  • 13 Weingrad DN, Decosse JJ, Sherlock P, Straus D, Lieberman PH, Filippa DA. Primary gastrointestinal lymphoma: A 30-year review. Cancer 1982;49:1258-65.
  • 14 Lewin KJ, Ranchod M, Dorfman RF. Lymphomas of the gastrointestinal tract: A study of 117 cases presenting with gastrointestinal disease. Cancer 1978;42:693-707.
  • 15 Andrews CN, John Gill M, Urbanski SJ, Stewart D, Perini R, Beck P. Changing epidemiology and risk factors for gastrointestinal non-Hodgkins lymphoma in a North American population: Population based study. Am J Gastroenterol 2008;103:1762-9.
  • 16 Sukpanichnant S, Udomsakdi-Auewarakul C, Ruchutrakool T, Leelakusolvong S, Boonpongmanee S, Chinswangwatanakul V. Gastrointestinal lymphoma in Thailand: A clinicopathologic analysis of 120 cases at Siriraj Hospital according to WHO classification. Southeast Asian J Trop Med Public Health 2004;35:966-76.
  • 17 Garg A, Dawar R, Agarwal V, Rustagi RK, Kochupillai V. Non-Hodgkin's lymphoma in Northern India. A retrospective analysis of 238 cases. Cancer 1985;56:972-7.
  • 18 Kushwaha MR, Chandra D, Misra NC, Misra PK, Agarwal SS. Leukaemias and lymphomas at Lucknow, India. Leuk Res. 1985;9:799-802.
  • 19 Azab MB, Henry-Amar M, Rougier P, Bognel C, Theodore C, Carde P, et al. Prognostic factors in primary gastrointestinal non-Hodgkin's lymphoma. A multivariate analysis, report of 106 cases, and review of the literature. Cancer 1989;64:1208-17.
  • 20 Isaacson PG. Gastrointestinal lymphoma. Hum Pathol 1994;25:1020-9.
  • 21 Delabie J, Holte H, Vose JM, Ullrich F, Jaffe ES, Savage KJ, et al. Enteropathy-associated T-cell lymphoma: Clinical and histological findings from the international peripheral T-cell lymphoma project. Blood 2011;118:148-55.
  • 22 Jores RD, Frau F, Cucca F, Grazia Clemente M, Orrù S, Rais M, et al. HLA-DQB1*0201 homozygosis predisposes to severe intestinal damage in celiac disease. Scand J Gastroenterol 2007;42:48-53.
  • 23 Mani H, Climent F, Colomo L, Pittaluga S, Raffeld M, Jaffe ES. Gall bladder and extrahepatic bile duct lymphomas: Clinicopathological observations and biological implications. Am J Surg Pathol 2010;34:1277-86.
  • 24 Taal BG, Van Heerde P, Somers R. Isolated primary oesophageal involvement by lymphoma: A rare cause of dysphagia: Two case histories and a review of other published data. Gut 1993;34:994-8.
  • 25 Shet T, Karpate A, Bal M, Gupta S, Gujral S, Nair R. Primary intestinal T cell lymphomas in Indian patients – In search of enteropathic T cell lymphoma. Indian J Pathol Microbiol 2010;53:455-9.