Euroasian Journal of Hepato-Gastroenterology

Register      Login

VOLUME 11 , ISSUE 2 ( July-December, 2021 ) > List of Articles

Original Article

Primary Intestinal Lymphoma: Clinicopathological Characteristics of 55 Patients

Renuka Malipatel, Mallikarjun Patil, Pritilata Rout, Marjorie Correa, Harshad Devarbhavi

Keywords : Diffuse large B-cell lymphoma (DLBCL), Intestine, Lymphoma, Non-Hodgkin\'s lymphoma (NHL), Primary

Citation Information : Malipatel R, Patil M, Rout P, Correa M, Devarbhavi H. Primary Intestinal Lymphoma: Clinicopathological Characteristics of 55 Patients. Euroasian J Hepatogastroenterol 2021; 11 (2):71-75.

DOI: 10.5005/jp-journals-10018-1345

License: CC BY-NC 4.0

Published Online: 22-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Gastrointestinal (GI) tract is the most common site of extranodal lymphoma accounting for 30–40% of the cases. In Western countries, stomach is the most common site of GI lymphoma, whereas in the Middle East and Mediterranean countries, small intestine is commonly involved. Studies about primary intestinal lymphoma (PIL) are heterogeneous in anatomical distribution, presentation, and histological subtypes. The present study was aimed at studying the anatomical distribution, histological subtypes, and clinical characteristics at tertiary care centers. Materials and methods: The present study was retrospective, conducted between 2006 and 2020. Patient\'s data were collected from institutional medical records. PIL was diagnosed by Lewin\'s criteria. After histological diagnosis, PIL was classified as per the World Health Organization (WHO) criteria and staging was done according to the Ann Arbor classification as modified by Musshoff. Results: A total of 941 lymphoma cases were diagnosed during the study period between 2006 and 2020 consisting of 238 Hodgkin\'s lymphoma and 703 non-Hodgkin\'s lymphoma (NHL) cases. PIL constituted 5.8% of all lymphoma cases (55 out of 941) and 50.9% (55 of 108) of all primary GI lymphoma. Median age at diagnosis was 44 years and comprised predominantly males (85.45%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma were the most common histological subtype (78%) seen. Two patients with primary Hodgkin\'s lymphoma involving the intestine were seen. T-cell lymphoma was seen in three (5.4%) patients. Ileocecal region was the most common site involved (27%). The common presenting complaints were intestinal obstruction (40%) requiring surgical resection and abdominal pain (32%). Majority of the patients presented in the early stages (I and II). Conclusion: Our study demonstrates the pattern of distribution and various histological subtypes of PIL including the rare variants like primary intestinal Hodgkin\'s lymphoma. Relatively more number of patients presented with intestinal obstruction requiring surgery in comparison with other studies.


PDF Share
  1. Devesa SS, Fears T. Non-Hodgkin's lymphoma time trends: United States and international data. Cancer Res 1992;52(19):5432s–5440s.
  2. Zheng T, Mayne ST, Boyle P, et al. Epidemiology of non-Hodgkin's lymphoma in Connecticut. Cancer 1992;70(4):840–849. DOI: 10.1002/1097-0142(19920815)70:4<840::aid-cncr2820700420> 3.0.co;2-i.
  3. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer 1972;29(1):252–260. DOI: 10.1002/1097-0142(197201)29:1<252::aid-cncr2820290138> 3.0.co;2-#.
  4. Herrmann R, Panahon AM, Barcos MP, et al. Gastrointestinal involvement in non-Hodgkin's lymphoma. Cancer 1980;46(1): 215–222. DOI: 10.1002/1097-0142(19800701)46:1<215::aid-cncr2820460136>3.0.co;2-6.
  5. Bautista-Quach MA, Ake CD, Chen M, et al. Gastrointestinal lymphomas: morphology, immunophenotype and molecular features. J Gastrointest Oncol 2012;3(3):209–225. DOI: 10.3978/j.issn.2078-6891.2012.024.
  6. Koch P, del Valle F, Berdel WE, et al. Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001;19(18):3861–3873. DOI: 10.1200/JCO.2001.19.18.3861.
  7. Gurney KA, Cartwright RA, Gilman EA. Descriptive epidemiology of gastrointestinal non-Hodgkin's lymphoma in a population-based registry. Br J Cancer 1999;79(11–12):1929–1934. DOI: 10.1038/sj.bjc.6690307.
  8. Warrick J, Luo J, Robirds D, et al. Gastrointestinal lymphomas in a North American population: clinicopathologic features from one major Central-Midwestern United States tertiary medical center. Diagn Pathol 2012;7:76. DOI: 10.1186/1746-1596-7-76.
  9. Papaxoinis G, Papageorgiou S, Rontogianni D, et al. Primary gastrointestinal non-Hodgkin's lymphoma: a clinicopathologic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma 2006;47(10):2140. DOI: 10.1080/10428190600709226.
  10. Salem P, El-Hashimi L, Anaissie E, et al. Primary small intestinal lymphoma in adults – a comparative study of IPSID versus non-IPSID in the Middle East. Cancer 1987;59(9):1670–1676. DOI: 10.1002/1097-0142(19870501)59:9<1670::aid-cncr2820590925>3.0.co;2-d.
  11. Al-Saleem T, Al-Mondhiry H. Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms. Blood 2005;105(6):2274–2280. DOI: 10.1182/blood-2004-07-2755.
  12. Lewin KJ, Ranchod M, Dorfman RF. Lymphomas of gastrointestinal tract: a study of 117 cases presenting with gastrointestinal disease. Cancer 1978;42(2):693–707. DOI: 10.1002/1097-0142(197808)42:2<693::aid-cncr2820420241>3.0.co;2-j.
  13. Musshoff K, Schmidt-Vollmer H. Prognosis of non-Hodgkin's lymphomas with special emphasis on the staging classification. ZKrebsforsch Klin Onkol Cancer Res Clin Oncol 1975;83(4):323–341. DOI: 10.1007/BF00573019.
  14. Swerdlow SH, Campo E, Harris NL, et al. World Health Organization classification of tumours of haematopoietic and lymphoid tissues. Revised 4th ed. Lyon, France: IARC; 2017.
  15. Amer MH, ei-Akkad S. Gastrointestinal lymphoma in adults: clinical features and management of 300 cases. Gastroenterology 1994;106(4):846–858. DOI: 10.1016/0016-5085(94)90742-0.
  16. Chandran R, Hemanth R, Harit KC. Primary gastrointestinal lymphoma: 30 years experience at the Cancer Institute, Madras, India. J Surg Oncol 1995;60(1):41–49. DOI: 10.1002/jso.2930600109.
  17. Malipatel R, Patil M, Pritilata Rout P, et al. Primary gastric lymphoma: clinicopathological profile. Eurosian J Hepatogastroenterol 2018;8(1):6–10. DOI: 10.5005/jp-journals-10018-1250.
  18. Raina V, Sharma A, Vora A, et al. Primary gastrointestinal non-Hodgkin's lymphoma chemotherapy alone an effective treatment modality: experience from a single centre in India. Indian J Cancer 2006;43(1):30–35. DOI: 10.4103/0019-509x.25773.
  19. Morgan DR, Holgate CS, Dixon MF, et al. Primary small intestinal lymphoma: a study of 39 cases. J Pathol 1985;147(3):211–221. DOI: 10.1002/path.1711470309.
  20. Kim SJ, Choi CW, Mun YC, et al. Multicenter retrospective analysis of 581 patients with primary intestinal non-Hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL). BMC Cancer 2011;11:321. DOI: 10.1186/1471-2407-11-321.
  21. Sweetenham JW, Mead GM, Wright DH, et al. Involvement of the ileocecal region by non-Hodgkin's lymphoma in adults: clinical features and results of treatment. Br J Cancer 1989;60(3):366–369. DOI: 10.1038/bjc.1989.286.
  22. Kohno S, Ohshima K, Yoneda S, et al. Clinicopathological analysis of 143 primary malignant lymphomas in the small and large intestines based on the new WHO classification. Histopathology 2003;43(2): 135–143. DOI: 10.1046/j.1365-2559.2003.01659.x.
  23. Wang SL, Liao ZX, Liu XF, et al. Primary early-stage intestinal and colonic non-Hodgkin's lymphoma: clinical features, management, and outcome of 37 patients. World J Gastroenterol. 2005 Oct 7; 11(37):5905–5909. DOI: 10.3748/wjg.v11.i37.5905.
  24. Wang GB, Xu GL, Luo GY, et al. Primary intestinal non-Hodgkin's lymphoma: a clinicopathologic analysis of 81 patients. World J Gastroenterol 2011; 17:4625–4631. DOI: 10.3748/wjg.v17.i41.4625.
  25. Nakamura S, Matsumoto T, Iida M, et al. Primary gastrointestinal lymphoma in Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 2003;97(10):2462–2473. DOI: 10.1002/cncr.11415.
  26. Nakamura S, Matsumoto T, Takeshita M, et al. Clinicopathologic study of primary small intestine lymphoma: prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma. Cancer 2000;88(2):286–294. DOI: 10.1002/(sici)1097-0142(20000115)88:2<286::aid-cncr7>3.0.co;2-z.
  27. Sharma S, Rana S, Kapur S, et al. Primary intestinal Hodgkin's lymphoma: an uncommon presentation. J Lab Physicians 2012;5(2):124–126. DOI: 10.4103/0974-2727.119866.
  28. Morgan PB, Kessel IL, Xiao SY, et al. Uncommon presentations of Hodgkin's disease. Case 1. Hodgkin's disease of the jejunum. J Clin Oncol 2004;22(1):193–195. DOI: 10.1200/JCO.2004.04.072.
  29. Delabie J, Holte H, Vose JM, et al. Enteropathy associated T-cell lymphoma: Clinical and histological findings from the international peripheral T- cell lymphoma project. Blood 2011;118(1):148–155. DOI: 10.1182/blood-2011-02-335216.
  30. Lee HH, Cho SG, Lee IS, et al. Mantle cell lymphoma with gastrointestinal involvement and the role of endoscopic examinations. PLoS One 2020;15(9):e0239740. DOI: 10.1371/journal.pone.0239740.
  31. Romaguera JE, Medeiros LJ, Hagemeister FB, et al. Frequency of gastrointestinal involvement and its clinical significance in mantle cell lymphoma. Cancer 2003;97(3):586–591. DOI: 10.1002/cncr.11096.
  32. Ferry JA. Burkitt lymphoma: clinicopathological features and differential diagnosis. Oncologist 2006;11(4):375–383. DOI: 10.1634/theoncologist.11-4-375.
  33. Rabkin C. Epidemiology of AIDS related malignancies. Curr Opin Oncol 1994;6(5):492–496. DOI: 10.1097/00001622-199409000-00008.
  34. Berel V, Peterman T, Berkelman R, et al. AIDS associated non-Hodgkin's lymphoma. Lancet 1991;33;7(8745):805–809. DOI: 10.1016/0140-6736(91)92513-2.
  35. Clarke C. Changing incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among young men in San Francisco. AIDS 2001;15(14):1913–1915. DOI: 10.1097/00002030-200109280-00035.
  36. Appleby P, Beral V, Newton R, et al. Highly active antiretroviral therapy and the incidence of cancer in human immunodeficiency virus-infected adults. J Natl Cancer Inst 2000;92(22):1823–1830. DOI: 10.1093/jnci/92.22.1823.
  37. Heise W. GI-lymphomas in immunosuppressed patients. Best Pract Res Clin Gastroenterol 2010;24(1):57–69. DOI: 10.1016/j.bpg.2010.01.001.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.