Gastric lymphoma
There are two kinds of lymphoma:
Non-Hodgkin (NHL) lymphomas, including gastric lymphoma;
Hodgkin's lymphoma or Hodgkin's disease.
Several types of gastric lymphomas
Gastrointestinal lymphomas account for 12.5% of all NHL. These are the most frequent NHL extra-ganglion (all of which account for about 30% of NHL cases). Gastrointestinal lymphomas account for only 3% of the malignant tumours of the stomach, 1% of the colon and rectum, and less than 18% of the small intestine tumours, which are also exceptional.
Gastric lymphoma: aggressive or indolent
Some gastrointestinal lymphomas are part of aggressive non-Hodgkin's lymphoma. It should be known that at the intestinal level all the NHL varieties can be found and that they may interest:
Only the digestive tract lymphocytes;
Simultaneously these lymphocytes and those of other lymphoid organs (lymph nodes, spleen, etc.).
B-cell or T-cell gastric lymphomas
Gastric lymphomas can be B lymphomas (in 90% of cases) or T lymphomas, which are much rarer. B-Cell Gastric lymphomas will be:
Small cell B lymphomas:
Mainly lymphomas of the marginal area of malt (or lymphomas of malt, i.e. lymphoid tissue associated with the digestive mucosa) of low malignancy but likely to evolve to become high malignancy;
Follicular lymphomas, which may be extra-ganglion gastric lymphomas (they do not develop in the lymph nodes);
The lymphomas of the mantle;
More rarely diffuse lymphomas with large B cells;
Burkitt lymphomas.
Small cell B lymphomas
Small cell B-gastric lymphomas are multiple.
Gastric lymphomas of the marginal area of MALT
Gastrointestinal lymphomas of the marginal area of MALT are the most frequent of small-cell lymphomas affecting the gastrointestinal tract. They often touch the stomach and a little less frequently the duodenum, the small intestine or the colon. Extra-Digestive locations (lung or marrow) are extremely rare. They develop in people with an average age of 60 years and mainly in men.
This cancer translates into:
Abdominal pain
Dyspepsia (pain and discomfort in the upper part of the abdomen);
Hemorrhage (ulcer) resulting in anemia.
As indolent lymphoma, evolution takes place slowly and the prognosis is rather favorable. The presence of the bacterium Helicobacter pylori is very common. In 80% of cases, its eradication results in a resolution of lymphoma in about 24 months. However, monitoring should be implemented to ensure that lymphoma is not relapsed.
Follicular gastric lymphomas
Two types of follicular lymphoma are distinguished:
Follicular lymphomas that appear as a result of lymphoma that has already developed in the lymph nodes are secondary lymphomas (they appear in a second time, after Ganglionic lymphoma).
Those that develop at the level of the gastrointestinal tract without the lymph nodes being reached are extra-ganglion, so-called primitive lymphomas. In this second case, the main location is the duodenum or the small intestine.
At the diagnostic level, lesions are present in the form of polyp-like white nodules. They may be isolated or associated with others located at the level of the small intestine. As in all follicular lymphomas, a translocation of 14 et18 chromosomes involving the BCL2 gene is found.
It is important to determine the stage of this lymphoma (from I to III) because it is based on it that the most suitable treatment will be determined. It goes from therapeutic forbearance with surveillance to high dose chemotherapy. Indeed, follicular lymphomas are very slow in evolution, but they can also become aggressive lymphomas.
Cancer polyp
Mantle lymphomas
The lymphomas of the mantle can be found in the context of gastrointestinal lymphomas, although they are aggressive lymphomas (not indolent and therefore rapid evolution):
They can be purely digestive and associate with lymphoma Polyposes. This results in lesions in the stomach, the small intestine or the colon.
They can also touch the lymph nodes and the digestive tract. In this case we find peripheral adenopathies (swollen lymph nodes and tonsils) and digestive.
Biological analyses show a translocation of chromosomes 11 and 14 involving the BCL1 gene and sometimes leukemia is observed. This type of gastrointestinal lymphoma must be taken care of in a specialized care unit, sometimes an autograft is necessary. It is indeed a lymphoma with a rapid evolution and therefore an adverse prognosis.
Leukemia
Large cell B Gastric lymphomas
As with mantle lymphomas, B lymphomas with large gastrointestinal cells are aggressive. So it can evolve very quickly.
These are unique, isolated lymphomas. They thus affect most often either the stomach or another part of the digestive tract (especially the junction between the small intestine and the colon), not both simultaneously.
The examination shows a large ulcerated tumor that could cause obstruction. These lymphomas will generate symptoms and a major alteration of the general condition. The treatment should involve chemotherapy, immunotherapy and possibly radiation therapy.
Burkitt lymphomas
Gastrointestinal Burkitt lymphomas are aggressive. They often translate into a large abdominal mass. It can sit at the level of the stomach or the junction zone between the small intestine and the colon (Carrefour ileocecal-cecal).
Generally, these lymphomas are accompanied by adenopathies mesenteric (swelling of the lymph nodes of the abdomen) and in 20% of the cases of peripheral adenopathies (swollen lymph nodes in other regions). In endoscopic exploration, large ulcerated tumors are found and therefore hemorrhagic. These intestinal lymphomas can affect the central nervous system.
Although these lymphomas are rapidly evolving, they generally respond well to chemotherapeutic treatment. This must be carried out however in emergency and in specialized environment.
Brain lymphoma
Gastrointestinal T-Lymphomas
Much rarer than B lymphomas, gastrointestinal T-lymphomas often appear in conjunction with another digestive pathology (e.g. celiac disease), although this is not systematic.
They result in lesions of the small intestine (jejunum in particular) and mesenteric adenopathies, the tumor cells in the intestinal mucosa.
These gastrointestinal lymphomas are bad prognosis. The only possible treatments are polychemotherapy and autografting.
In all cases, regardless of the nature of gastrointestinal lymphoma, multidisciplinary care is required. In particular, it must bring together pathologists, oncologists and hematologists.
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