Clinical Features of Primary Malignant Gastric Lymphoma: Analysis of 35 Cases

Background: The clinical manifestations of primary malignant gastric lymphoma (PMGL) are non-specific, and the diagnostic accuracy of endoscopy and upper gastrointestinal barium meal is relatively low. Aims: To investigate the clinical features of PMGL, which may benefit its early diagnosis, early treatment and improve the prognosis. Methods: The medical records of PMGL patients in Shanghai Renji Hospital from Sep. 2000 to Feb. 2006 were analyzed retrospectively. Results: Thirty-five PMGL patients were enrolled in this study. The main gastrointestinal manifestation was epigastric pain with infrequent systemic symptoms. Endoscopically, ulceration, diffused infiltration and nodular mass were seen in 67.7%, 22.6% and 9.7% of the cases, respectively, and the lesions were located mainly in the antrum and body of stomach. The diagnosis rate of biopsy specimen pathology was 54.5%. All 35 cases were diagnosed as B-cell non-Hodgkin lymphoma pathologically, of them 5 were mucosa-associated lymphoid tissue (MALT) lymphoma, 26 were diffuse large B cell lymphoma (DLBCL), and 4 were DLBCL associated with MALT lymphoma (DLBCML). The prognosis was correlated with histological type, clinical staging and the serum level of lactate dehydrogenase (LDH) (P0.05). The postoperative 3-year survival rate was 81.8%. Conclusions: Local presentation of PMGL is severe but the performance status is good. The lesions observed at endoscopy are large, more extensive, and involving multiple sites. Multiple and deep biopsy should be used to improve the endoscopic diagnosis rate. The therapeutic regimen should be selected in accordance with histological type, clinical staging, and the presence of Helicobacter pylori infection.