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14 HF-Limfoma GI Tract
14 HF-Limfoma GI Tract
14 HF-Limfoma GI Tract
Overview
HL is rare in GI tract
Marginal zone –
memory
cells’ residence
Mantle – Naïve(unexposed) B
cells zone
Family of GI lymphomas
Gastric – Other sites
Marginal Zone B cell lymphoma/ MALToma Walyder’s ring
Diffuse large B cell lymphoma(DLBCL) Esophagus
Uncommon types Liver and biliary tree
Small intestinal Pancreas
B-cell Colon, rectum and anus
IPSID
Non-IPSID Immunodeficiency – related
MALToma Post transplant
DLBCL HIV associated
Mantle
Follicular
Burkitt’s
T-cell
Enteropathy associated T cell lymphoma
Distribution
More than 1 Rectum Diffuse
site 2% colonic
13% 1%
Ilececal
7%
SI
9%
Stomach
68%
Paris
T1-T4 – mucosal to adjacent organ invasion
N1-N3 – regional to extra abdominal spread
M – mets non contiguous involvement
B – bone marrow infiltration
S tag e I - The tumor is confined to the gastrointestinal tract. I t can
be a single primary lesion or multiple, noncontiguous lesions.
Stage l l - The tumor extends into the abdomen . This is further
subdivided based upon the location of nodal involvement:
Immune response
Hp infection Hp specific T cell
and MALT formation
Somatic
Growth signals to B hypermutation in Ig
B cell proliferation
cells to increase Ag
affinity
Autonomy -
Continued B cell
Accumulation of Independence from
proliferation for
genetic aberrations T cell for growth
prolonged time
factors
Immuno-histochemistry and molecular
tests
Molecular test
PCR assay of immunoglobulin heavy chain assist in
documentation of monoclonality
But monoclonality may also be seen in gastritis
Not for practical purposes - reser ved for research
Diagnosis
Endoscopy findings
Er ythema
Erosions
Ulcers
Jumbo biopsy, snare biopsies, well technique and needle aspiration can
increase yield in suspected cases
But rest of the DLBCL have no e/o of low grade MALToma tissue
Microscopic examination
Unlike MALToma PET-CT has special role in DLBCL, more sensitive than
BM biopsy
Traditionally surger y was 1st choice – 70% stage 1 disease free for 5
years but 5% -10% risk mortality
Chemo if DLBCL
Primar y pancreatic lymphoma – presentation similar
to adenoca – pain, obs jaundice, chylous ascites
HPE usually – DLBCL
Rx – CHOP-R
When Bil is high, stenting to ease chemo