Endoscopy findings7/14/2023 ![]() The majority of gastric lymphomas are non-Hodgkin’s lymphoma (NHL) of B-cell origin. The stomach is the most common site with secondary lymphomas. Primary gastric lymphoma is an uncommon condition accounting for less than 15% of gastric malignancies and about 2% of all lymphomas. Malignant lymphomas affect the stomach as a primary tumor or as part of a widespread disease process. Endocytoscopy would be applicable for virtual histopathological diagnosis of different lymphoproliferative disorders and their clinical assessment during ongoing endoscopy. The inter-glandular infiltration seen on endocytoscopy can indicate the lymphoepithelial lesions seen in MALT lymphoma and related DLBCL. Nuclear regularity in size and configuration may indicate the cytological grade, differentiating the indolent low-grade from aggressive lymphoproliferative diseases. On endocytoscopy, intra-glandular aggregation of cellular components was invariably identified in lymphomas of the stomach. In the 2 patients with CR who underwent repeat endocytoscopy, the ultra-high magnification abnormalities returned to normal, while they were unchanged in those without tumor regression. Complete regression (CR) was observed in 2 of the 7 MALT lymphoma patients. Endocytoscopy could identify the disease-specific histology, the lymphoepithelial origin, as inter-glandular infiltration of cellular components in MALT lymphoma and the possibly related DLBCL cases. Inter-glandular infiltration by lymphomatous cell elements was frequently observed in MALT lymphoma and DLBCL, but it was uncommon in peripheral gastric T-cell malignancies. The nuclear diversity in size and configuration was exclusively seen in gastric lymphomas other than MALT lymphoma, whereas the nuclei of MALT lymphoma cells were regular and small to moderate in size. Endocytoscopy showed mucosal aggregation of interstitial cellular elements in almost all gastric lymphoma cases. NBI magnification endoscopy invariably showed dilatation or ballooning and destruction of gastric pits and elongation and distortion in microvessels. pylori treatment was given in the 7 MALT lymphoma cases. On conventional endoscopy, 9 were classified as having superficial spreading type, 7 were mass-forming type, and 1 was diffuse infiltrating type. The lesions consisted of 7 with low-grade mucosa-associated lymphoid tissue (MALT), 5 with gastric involvement by adult T-cell leukemia/lymphoma (ATLL), 4 with diffuse large B-cell lymphoma (DLBCL), and 1 with peripheral T-cell lymphoma. MethodsĮndocytoscopy and magnifying endoscopy with narrow band imaging (NBI) were performed in 17 patients with lymphomas of the stomach. The gastric lesions of various lymphomas were observed at the cellular level using endocytoscopy.
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