Gastric lymphoma
Updates to Article Attributes
Gastric lymphoma may either represent secondary involvement by systemic disease or primary malignancy confined to the stomach.
Epidemiology
Gastric lymphoma represents the most common site of extranodal lymphoma, accounting for 25% of all such lymphomas, 50% of all gastrointestinal lymphomas, but comprise only 1-5% of all gastric malignancies 1-3,8.
Typically primary gastric lymphoma occurs in adults in the 6th decade of life, without gender predilection 9. Secondary gastric lymphoma matches the demographics of the underlying lymphoma.
Clinical presentation
Typically patients present with long standing epigastric pain and or dyspepsia which is attributable to Helicobacter pylori rather than the lymphoma per se 6.
Pathology
Three distinct types of gastric lymphoma are recognised 7-8:
- low-grade MALT lymphoma: 60% of all primary gastric lymphomas
- primary sporadic lymphoma: vast majority are B-cell non-Hodgkins lymphoma
- secondary involvement of the stomach by systemic lymphoma (usually high grade)
Mucosa-associated lymphoid tissue (MALT) lymphoma are strongly associated with Helicobacter pylori(85-98% of cases). These are low-grade lymphomas and may regress following treatment of Helicobacter infection 6.
Radiographic features
Fluoroscopy: barium meal
Appearances vary from normal, to grossly abnormal. Possible appearances include:
- bull's eye appearance due to central ulceration 4
- filling defects
- thickened gastric rugae
- linitis plastica
CT
Typically gastric lymphomas demonstrate marked thickening of the stomach wall (2-4cm) with extensive lateral extension of the tumour (i.e. along the wall of the stomach) representing submucosal spread 3.
In some instances the submucosal spread encompasses the majority of the stomach, giving it a linitis plastica appearance. Such extensive mural involvement can also extend across the pylorus into the duodenum and superiorly into the oesophagus 5.
Despite such extensive involvement it is uncommon for lymphoma to result in gastric outlet obstruction 3 or perigastric fat invasion.
The mass is usually homogeneous in attenuation, but may contain focal areas of low density representing necrosis.
Extensive retroperitoneal and local nodal enlargement is often seen.
Differential diagnosis
General imaging differential considerations include:
-
gastric carcinoma
- more likely to cause gastric outlet obstruction 3
- more likely to be in the distal stomach
- more likely to extend beyond the serosa and obliterate adjacent fat plane
- more focal
- lymph nodes tend to be smaller and more localized to immediate draining nodes
(Unlike(unlike in gastric carcinoma, gastric lymphomas are associated with bulky lymph nodes, theand with adenopathy often extending below the level of renal veins/hilum10).
- gastrointestinal stromal tumour (GIST)
For diffuse gastric wall thickening also consider:
- gastritis
- Menetrier's disease: has a rugal like pattern
-<li>lymph nodes tend to be smaller and more localized to immediate draining nodes (Unlike in gastric carcinoma, gastric lymphomas are associated with bulky lymph nodes, the adenopathy extending below the level of renal veins/hilum<sup>10</sup>).</li>- +<li>lymph nodes tend to be smaller and more localized to immediate draining nodes (unlike in gastric carcinoma, gastric lymphomas are associated with bulky lymph nodes and with adenopathy often extending below the level of renal veins/hilum<sup>10</sup>).</li>
References changed:
- 10. Miller FH, Kochman ML, Talamonti MS et-al. Gastric cancer. Radiologic staging. Radiol. Clin. North Am. 1997;35 (2): 331-49. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9087207">Pubmed citation</a><span class="auto"></span>
- 10. Miller FH, Kochman ML, Talamonti MS, Ghahremani GG, Gore RM. Gastric cancer: radiologic staging. Radiol Clin North Am 1997; 35:331-349.
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