Endoscopic criteria for early differential diagnosis of gastritis-like form of primary non-Hodgkin's lymphomas and gastric cancer: A prospective study

Cover Page

Cite item

Full Text

Abstract

Aim. To reveal and study basic endoscopic differential-significant criteria characterizing gastric-like form of primary non-Hodgkin's lymphoma (NHL) from adenocarcinoma and signet-ring cell carcinoma (SRCC) of the stomach.

Materials and methods. In the prospective study, based of Blokhin National Medical Research Center of Oncology in the period from 2019 to June 2023, 106 patients with gastritic-like forms of primary NHL, adenocarcinoma and SRCC of the stomach were analyzed. Complex endoscopic study included examination in the modes of white light, magnification, narrow-band imaging (NBI, BLI, LCI) was done.

Results. All patients were divided into three groups: MALT gastric lymphoma (38 patients, 35.8%), gastric adenocarcinoma (33 patients, 31.1%), and SRCC (35 patients, 33.1%). At MALT-lymphoma the tumor was localized in the antrum of the stomach (52.6%),adenocarcinoma and SRCC – in the body (45.5 and 60%). In the tumor structure in MALT-lymphoma of the stomach in 100% of cases multiple point areas of microdepressions and multicenter character of the lesion were determined. At adenocarcinoma – depressed area in the central part of tumor (45.5%), at SRCC – extended areas of microdepressions (51.4%) and multicentric character of lesions. At MALT-lymphoma the pit pattern in 63.2% is of "balloon" type, vascular – of tree-like type (84.2%). In adenocarcinoma the vascular pattern was of the loop-type (42.4%), in SRCC – of the corkscrew-type (74.3%). Demarcation line was observed only in adenocarcinoma (100%). At endosonographic study at MALT-lymphoma the tumor was coming from deep layers of mucous coat (100%), changes of regional lymph nodes (LN) were absent, at adenocarcinoma – from mucous membrane (100%), LN were not changed, at SRCC – submucous spread of tumor (100%), changes in LN (40%).

Conclusion. Complex endoscopic examination is necessary to improve the quality of endoscopic examination of malignant gastric-like tumors, to determine the depth of invasion and spread of the tumor process, to assess the regional lymph drainage.

About the authors

Valeria V. Lozovaia

Blokhin National Medical Research Center of Oncology

Author for correspondence.
Email: lera.lozovaya@bk.ru
ORCID iD: 0000-0001-6262-7763

endoscopist

Russian Federation, Moscow

Olga A. Malikhova

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Email: malikhova@inbox.ru
ORCID iD: 0000-0003-0829-7809

d. sci. (med.)

Russian Federation, Moscow

Armen O. Tumanyan

Blokhin National Medical Research Center of Oncology

Email: tumanyan.armen.o@yandex.ru
ORCID iD: 0000-0001-5863-5197

d. sci. (med.)

Russian Federation, Moscow

Olga A. Gusarova

Blokhin National Medical Research Center of Oncology

Email: o.a.gusarova@mail.ru
ORCID iD: 0000-0001-6179-1115

medical resident

Russian Federation, Moscow

References

  1. 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;47:2140-6. doi: 10.1080/10428190600709226
  2. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17(6):697-707. doi: 10.3748/wjg.v17.i6.697
  3. Vlăduţ C, Ciocîrlan M, Costache, et al. Is mucosa-associated lymphoid tissue lymphoma an infectious disease? Role of Helicobacter pylori and eradication antibiotic therapy (Review). Exp Ther Med. 2020;20(4):3546-53. doi: 10.3892/etm.2020.9031
  4. Feldman M, Lawrence JB. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th edition. Philadelphia: Elsevier Saunders, 2015; 473-7.
  5. Sugita S, Iijima T, Furuya S, et al. Gastric T-cell lymphoma with cytotoxic phenotype. Pathol Int. 2007;57(2):108-14. doi: 10.1111/j.1440-1827.2006.02065.x
  6. Bhandari A, Crowe SE. Helicobacter pylori in Gastric Malignancies. Curr Gastroenterol Rep. 2012;14(6):489-96. doi: 10.1007/s11894-012-0296-y
  7. Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther. 2011;34(9):1047-62. doi: 10.1111/j.1365-2036.2011.04839.x
  8. Hussell T, Isaacson PG, Crabtree JE, Spencer J. Helicobacter pylori-specific tumour-infiltrating T cells provide contact dependent help for the growth of malignant B cells in low-grade gastric lymphoma of mucosa-associated lymphoid tissue. J Pathol. 1996;178(2):122-7. doi: 10.1002/(SICI)1096-9896(199602)178:2<122::AID-PATH486>3.0.CO;2-D
  9. Ruskoné-Fourmestraux A, Fischbach W, Aleman BM, et al. EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut. 2010;60(6):747-58. doi: 10.1136/gut.2010.224949
  10. Ruskoné-Fourmestraux A, Dragosics B, Morgner A, et al. Paris staging system for primary gastrointestinal lymphomas. Gut. 2003;52(6):912-3. doi: 10.1136/gut.52.6.912
  11. Малихова О.А. Современная стратегия комплексной эндоскопической диагностики и мониторинг неходжкинских лимфом желудка. Дис. … д-ра мед. наук. М., 2010 [Malikhova OA. Sovremennaia strategiia kompleksnoi endoskopicheskoi diagnostiki i monitoring nekhodzhkinskikh limfom zheludka. Dis. … d-ra med. nauk. Moscow, 2010 (in Russian)].
  12. Kelessis NG, Vassilopoulos PP, Tsamakidis KG, et al. Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue. Surg Endosc. 2003;17(3):469-74. doi: 10.1007/s00464-002-8544-0
  13. Nonaka K, Ishikawa K, Arai S, et al. A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis. World J Gastrointest Endosc. 2012;4(4):151-6. doi: 10.4253/wjge.v4.i4.151
  14. Deng P, Min M, Ma CY, Liu Y. Linked color imaging technology for diagnosis of gastric mucosa-associated lymphoid tissue lymphoma. Chin Med J (Engl). 2017;130(22):2759-60. doi: 10.4103/0366-6999.214137
  15. Mehra M, Agarwal B. Endoscopic diagnosis and staging of mucosa-associated lymphoid tissue lymphoma. Curr Opin Gastroenterol. 2008;24(5):623-6. doi: 10.1097/MOG.0b013e32830bf80f
  16. Iftikhar J, Siddique MZ, Saqib M, et al. Gastric lymphoma: severe gastric outlet obstruction warranting stent placement. J Coll Physicians Surg Pak. 2022;32(8):S150-2. doi: 10.29271/jcpsp.2022.Supp2.S150
  17. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82(2):228-31. PMID: 7054024
  18. Chiarello MM, Fico V, Pepe G, et al. Early gastric cancer: A challenge in Western countries. World J Gastroenterol. 2022;28(7):693-703. doi: 10.3748/wjg.v28.i7.693
  19. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. doi: 10.3322/caac.21660
  20. Murakami T, Shoji T, Suzuki K, et al. Simultaneous occurrence of early gastric carcinoma and mucosa-associated lymphoid tissue lymphoma of the omentum. Case Rep Gastroenterol. 2014;8(1):101-6. doi: 10.1159/000362158
  21. Suwa T, Uotani T, Inui W, et al. A case of signet ring cell carcinoma and mucosa-associated lymphoid tissue lymphoma of the stomach diagnosed simultaneously via magnifying endoscopy with narrow-band imaging. Clin J Gastroenterol. 2021;14(2):453-9. doi: 10.1007/s12328-020-01325-y
  22. Peng T, Deng L, Wang Y, et al. Establishing an endoscopic diagnostic process system (M-system) for gastric MALT lymphoma of superficial-spreading type. Jpn J Clin Oncol. 2021;51(4):560-8. doi: 10.1093/jjco/hyaa242
  23. Kawamura M, Abe S, Oikawa K, et al. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J Gastroenterol Hepatol. 2011;26(3):477-83. doi: 10.1111/j.1440-1746.2010.06527.x

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Gastritis-like form of primary non-Hodgkin's lymphomas (NHL) of the stomach by the type of erosive gastritis which viewed in white light mode: A flat-towering tumor infiltration is determined, with a hyperemic loosened surface, with multiple eroded areas, irregular in shape, covered with a coating of fibrin (indicated by blue arrows). In the structure of the tumor, convoluted microvessels of a tree type are determined (indicated by a white arrow).

Download (154KB)
Indexing metadata
3. Fig. 2. Adenocarcinoma of the antrum of the stomach which viewed in white light mode: Two adjacent flat-towering epithelial formations are determined, oval in shape, with an irregular pit pattern at the top of the formations, with an enhanced microvascular pattern.

Download (159KB)
Indexing metadata
4. Fig. 3. Signet ring cell carcinoma of the stomach which viewed in white light mode: In the body of the stomach, there is a thickening of the posterior wall and a large curvature due to submucosal tumor infiltration. The surface of the tumor is hyperemic, convoluted microvessels and point erosions are determined in the structure of the tumor (indicated by white arrows).

Download (212KB)
Indexing metadata
5. Fig. 4. Gastritis-like form of primary NHL of the stomach by the type of erosive gastritis which viewed in a narrow-spectrum mode (NBI): In the structure of the tumor, atrophic changes are determined (indicated by a blue arrow); a violation of the pitting pattern in the form of expansion, elongation and deformation of the fossae in the form of a “balloon” (indicated by white arrows) and non-differentiated changes in areas covered with fibrin plaque, which corresponds to the area of erosed areas (indicated with a red arrow); tree-like changes in the vascular pattern are determined (indicated by a yellow arrow).

Download (151KB)
Indexing metadata
6. Fig. 5. Adenocarcinoma of the antrum of the stomach which viewed in a narrowspectrum mode (NBI): There is a clear border in the form of a demarcation line between the tumor tissue and the unchanged gastric mucosa (indicated by a white arrow). The pit pattern in the central part of the tumor is not differentiated (indicated by a blue arrow), on the periphery of the formation it is irregular, the patterns of which are curved, deformed (indicated by a red arrow).

Download (176KB)
Indexing metadata
7. Fig. 6. Signet ring cell carcinoma of the body of the stomach when examined in a narrow-spectrum mode (NBI): In the structure of the tumor, there is an alternation of areas of visually unchanged mucous membrane with areas of changes in the type of expansion of gastric fields, elongation of patterns (indicated by a red arrow) and amorphous non-differentiated areas (indicated by a blue arrow).

Download (263KB)
Indexing metadata

Copyright (c) 2023 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies