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Key Features

  • Second most common gastric malignancy, 3–5% of gastric cancers

  • More than 95% are non-Hodgkin B-cell lymphomas consisting of mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma

  • Gastric T-cell lymphoma, associated with HTLV-1 infection, is rare and makes up 7% of primary gastric lymphomas

  • Infection with Helicobacter pylori is an important risk factor for primary gastric lymphoma

  • > 90% of low-grade primary gastric lymphomas are associated with H pylori

Clinical Findings

  • Dyspepsia

  • Abdominal pain

  • Weight loss

  • Upper GI bleeding

  • Anemia

Diagnosis

  • Endoscopic ultrasonography is the most sensitive test for determining the level of invasion and presence of perigastric lymphadenopathy

  • CT scanning of chest, abdomen, and pelvis useful in staging

  • For patients with diffuse large B-cell lymphomas involving the stomach, the following may be required for staging and management

    • Combination PET-CT imaging

    • Bone marrow biopsy with aspirate

    • Tumor lysis laboratory tests

    • Viral hepatitis and HIV serologies

Treatment

  • Primary low-grade gastric lymphomas

    • Usually localized to the stomach wall (stage IE) or perigastric lymph nodes (stage IIE1)

    • Have an excellent prognosis

  • After successful H pylori eradication, complete lymphoma regression occurs in ~75% of cases of stage IE low-grade lymphoma and in ~55% with stage IIE low-grade lymphoma

  • MALT-type lymphomas

    • Patients who are not infected with H pylori or do not respond to eradication therapy can be treated successfully with radiation therapy (or with rituximab if not a candidate for radiation)

    • However, hepatitis B reactivation can occur with rituximab, including fatal cases of fulminant hepatitis

    • Surgical resection is no longer recommended because of a low risk of perforation with either radiation therapy or chemotherapy

    • Long-term survival of primary gastric lymphoma for stage I is > 90% and for stage II, 35–65%

  • Diffuse large B-cell lymphoma

    • Surgery has been associated with a better prognosis than conservative treatment

    • Usually presents at an advanced stage with widely disseminated disease and is treated according to stage and subtype of lymphoma

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