Gastrointestinal Manifestations of Mature B Cell Neoplasms: Single Center Experiences from the Collective Perspective of Hematology and Pathology
Öz
Background/aim: Hematological malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract or as the primary process, developing in the GI tract. The prevalence of gastrointestinal non-Hodgkin’s lymphomas (gNHL) is smaller than other solid organ tumours of the GI tract. Therefore, in the absence of nodal or extranodal involvement in imaging methods, difficulties may be encountered in diagnosis.
Materials and Methods: We retrospectively screened all B-cell lymphoma patients. Then, patients, who had been diagnosed without gastrointestinal system biopsy, were excluded from the study. Demographic data for these patients was obtained from the hospital information system and outpatient clinic files. Slides of these patients were obtained from pathology archive and re-evaluated under light microscope by two pathologists. All cases were diagnosed in line with revised World Health Organization (WHO) 2017 classification.
Results: Fifty-five patients were diagnosed with B-cell lymphoma via endoscopic or colonoscopic biopsies. Forty of these patients were diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL), ten with Marginal Zone Lymphoma (MZL), two with Mantle Cell Lymphoma (MCL), two with Burkitt Lymphoma (BL) and one patient with Lymphoplasmacytic Lymphoma (LPL).
Conclusion: In line with the literature, in our study, the patients with GI tract diagnosis had the highest frequency of DLBCL. The second most common B-cell lymphoma was MALToma. Although the frequency of GI involvement is high in MCL, the number of patients, diagnosed with GI involvement was small. The reason for this was that the patients had been diagnosed on the basis of nodal involvement rather than GI biopsy.
Anahtar Kelimeler
non-Hodgkin’s lymphomas B-cell neoplasm Gastrointestinal lymphomas
Kaynakça
- 1) Bautista-Quach MA, Ake CD, Chen M, Wang J. Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features. J Gastrointest Oncol. 2012 Sep;3(3):209-25. 2) Chin CK, Tsang E, Mediwake H, Khair W, Biccler J, Hapgood G, et al. Frequency of bowel perforation and impact of bowel rest in aggressive non-Hodgkin lymphoma with gastrointestinal involvement. Br J Haematol. 2019 Mar;184(5):826-828. 3) Herrmann R, Panahon AM, Barcos MP, Walsh D, Stutzman L. Gastrointestinal involvement in non-Hodgkin's lymphoma. Cancer. 1980 Jul 1;46(1):215-22.
- 4) Small S, Barnea Slonim L, Williams C, Karmali R. B Cell Lymphomas of the GI Tract. Curr Gastroenterol Rep. 2021 May 8;23(7):9.
- 5) Tran QT, Nguyen Duy T, Nguyen-Tran BS, Nguyen-Thanh T, Ngo QT, Tran Thi NP, et al. Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study. Diagnostics (Basel). 2023 Aug 26;13(17):2767.
- 6) Kanno T, Katano T, Shimura T, Nishigaki R, Kojima Y, Sasaki M, et al. Characteristic endoscopic findings of gastrointestinal malignant lymphomas other than mucosa-associated lymphoid tissue lymphoma. Acta Gastroenterol Belg. 2022 Jul-Sep;85(3):477-483.
- 7) Alvarez-Lesmes J, Chapman J.R, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery E.A, et al. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 1 December 2021; 145 (12): 1585–1596.
- 8) Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, et al. Endoscopic features of gastro-intestinal lymphomas: from diagnosis to follow-up. World J Gastroenterol. 2014 Sep 28;20(36):12993-3005.
- 9) Olszewska-Szopa M, Wróbel T. Gastrointestinal non-Hodgkin lymphomas. Adv Clin Exp Med. 2019 Aug;28(8):1119-1124.
- 10) Swerdlow SH CE, Harris NL, Jaffe ES, Pileri SA, Stein H. WHO classification of tumours of haematopoietic and lymphoid tissues-Revised 4th edition. World Health Organization Classification of Tumours. 2017.
- 11) Hanafy AK, Morani AC, Menias CO, Pickhardt PJ, Shaaban AM, Mujtaba B, et al. Hematologic malignancies of the gastrointestinal luminal tract. Abdom Radiol (NY). 2020 Oct;45(10):3007-3027.
- 12) Pizzi M, Sabattini E, Parente P, Bellan A, Doglioni C, Lazzi S. Gastrointestinal lymphoproliferative lesions: a practical diagnostic approach. Pathologica. 2020 Sep;112(3):227-247.
- 13) Harlendea NJ, Harlendo K. Ki-67 as a Marker to Differentiate Burkitt Lymphoma and Diffuse Large B-cell Lymphoma: A Literature Review. Cureus. 2024 Oct 23;16(10):e72190.
- 14) Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004 Jan 1;103(1):275-82.
- 15) Meyer PN, Fu K, Greiner TC, Smith LM, Delabie J, Gascoyne RD, et al. Immunohistochemical methods for predicting cell of origin and survival in patients with diffuse large B-cell lymphoma treated with rituximab. J Clin Oncol. 2011 Jan 10;29(2):200-7.
- 16) Gualco G, Bacchi LM, Domeny-Duarte P, Natkunam Y, Bacchi CE. The contribution of HGAL/GCET2 in immunohistological algorithms: a comparative study in 424 cases of nodal diffuse large B-cell lymphoma. Mod Pathol. 2012 Nov;25(11):1439-45.
- 17) Hu S, Xu-Monette ZY, Balasubramanyam A, Manyam GC, Visco C, Tzankov A, et al. CD30 expression defines a novel subgroup of diffuse large B-cell lymphoma with favorable prognosis and distinct gene expression signature: a report from the International DLBCL Rituximab-CHOP Consortium Program Study. Blood. 2013 Apr 4;121(14):2715-24.
- 18) Peña C, Villegas P, Cabrera ME. Double or triple-expressor lymphomas: prognostic impact of immunohistochemistry in patients with diffuse large B-cell lymphoma. Hematol Transfus Cell Ther. 2020 Apr-Jun;42(2):192-193.
- 19) Shirwaikar Thomas A, Schwartz M, Quigley E. Gastrointestinal lymphoma: the new mimic. BMJ Open Gastroenterol. 2019 Sep 13;6(1):e000320.
- 20) Matysiak-Budnik T, Priadko K, Bossard C, Chapelle N, Ruskoné-Fourmestraux A. Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist's Point of View. Cancers (Basel). 2023 Jul 27;15(15):3811.
- 21) Cheah CY, Seymour JF. Marginal zone lymphoma: 2023 update on diagnosis and management. Am J Hematol. 2023 Oct;98(10):1645-1657.
- 22) Xia Y, Ge J, Sun Z, Nan F, Wan W, Xu D, et al. CD5-positive marginal zone lymphoma: Clinicopathological features and survival outcomes. Leuk Res. 2022 Jun;117:106840.
- 23) Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol. 2019 Jun;94(6):710-725.
- 24) Nguyen V, Nguyen B, Petris GD, Nguyen C. Education and imaging. Gastrointestinal: gastrointestinal involvement of mantle cell lymphoma. J Gastroenterol Hepatol. 2012 Mar;27(3):617.
- 25) Li S, Xu J, You MJ. The pathologic diagnosis of mantle cell lymphoma. Histol Histopathol. 2021 Oct;36(10):1037-1051.
- 26) Al-Mansour M. Treatment Landscape of Relapsed/Refractory Mantle Cell Lymphoma: An Updated Review. Clin Lymphoma Myeloma Leuk. 2022 Nov;22(11):e1019-e1031.
- 27) Iwamuro M, Tanaka T, Okada H. Review of lymphoma in the duodenum: An update of diagnosis and management. World J Gastroenterol. 2023 Mar 28;29(12):1852-1862.
- 28) Fischer L, Dreyling M. Follicular lymphoma: an update on biology and optimal therapy. Leuk Lymphoma. 2023 Apr;64(4):761-775.
- 29) Takata K, Sato Y, Nakamura N, Tokunaka M, Miki Y, Yukie Kikuti Y, et al. Duodenal follicular lymphoma lacks AID but expresses BACH2 and has memory B-cell characteristics. Mod Pathol. 2013;26(1):22-31.
- 30) Roschewski M, Staudt LM, Wilson WH. Burkitt's Lymphoma. N Engl J Med. 2022 Sep 22;387(12):1111-1122.
- 31) López C, Burkhardt B, Chan JKC, Leoncini L, Mbulaiteye SM, Ogwang MD, et al. Burkitt lymphoma. Nat Rev Dis Primers. 2022 Dec 15;8(1):78.
- 32) Chong Y, Kim TE, Cho U, Jin MS, Yim K, Thakur N, et al. Comparison of Ki-67 Labeling Index Patterns of Diffuse Large B-Cell Lymphomas and Burkitt Lymphomas Using Image Analysis: A Multicenter Study. Diagnostics (Basel). 2021 Feb 19;11(2):343.
Öz
Amaç: Hematolojik maligniteler gastrointestinal (GI) sistemi sıklıkla tutmaktadır. Bu tutulum birincil olarak GI lümenden kaynaklanabildiği gibi, ikincil olarak ekstra nodal ve ya ekstramedüller yayılım ile gerçekleşebilir. Hodgkin dışı lenfomaların GI lümende görülme sıklığı solid organ kanserlerine göre daha azdır. Bu neden ile tanı konulması nodal ve veya ekstra nodal tutulum yokluğunda zor olabilir.
Yöntemler: Tüm B hücreli lenfoma hastalarını retrospektif olarak tarandı. Gastrointestinal sistem biyopsisi yapılmadan tanı konulan hastalar çalışma dışı bırakıldı. Bu hastalara ait demografik veriler hastane bilgi sistemi ve poliklinik dosyalarından elde edildi. Hastalara ait slaytlar patoloji arşivinden alınarak iki patolog tarafından ışık mikroskobu altında yeniden değerlendirildi.
Bulgular: Elli beş hastaya endoskopik veya kolonoskopik biyopsilerle B hücreli lenfoma tanısı konuldu. Bu hastaların 40'ına Diffüz Büyük B Hücreli Lenfoma (DBBHL), 10'una Marjinal Zon Lenfoma (MZL), ikisine Mantle Hücreli Lenfoma (MHL), ikisine Burkitt Lenfoma (BL) ve bir hastaya da Lenfoplazmasitik Lenfoma (LPL) tanısı konuldu.
Sonuç: Literatürle uyumlu olarak çalışmamızda gastrointestinal sistem tanısı alan hastalarda DBBHL sıklığının en yüksek olduğu görüldü. İkinci en sık görülen B hücreli lenfoma MALToma idi. MHL hastalarında literatüre göre Gİ tutulum saptanan hasta sayısı azdı. Bunun nedeni olarak hastaların Gİ tutulumu ile değil nodal tutuluma göre tanı konmuş olduğu düşünüldü.
Anahtar Kelimeler
Hodgkin dışı lenfomalar B hücreli neoplasm Gastrointestinal lenfomalar Patoloji
Kaynakça
- 1) Bautista-Quach MA, Ake CD, Chen M, Wang J. Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features. J Gastrointest Oncol. 2012 Sep;3(3):209-25. 2) Chin CK, Tsang E, Mediwake H, Khair W, Biccler J, Hapgood G, et al. Frequency of bowel perforation and impact of bowel rest in aggressive non-Hodgkin lymphoma with gastrointestinal involvement. Br J Haematol. 2019 Mar;184(5):826-828. 3) Herrmann R, Panahon AM, Barcos MP, Walsh D, Stutzman L. Gastrointestinal involvement in non-Hodgkin's lymphoma. Cancer. 1980 Jul 1;46(1):215-22.
- 4) Small S, Barnea Slonim L, Williams C, Karmali R. B Cell Lymphomas of the GI Tract. Curr Gastroenterol Rep. 2021 May 8;23(7):9.
- 5) Tran QT, Nguyen Duy T, Nguyen-Tran BS, Nguyen-Thanh T, Ngo QT, Tran Thi NP, et al. Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study. Diagnostics (Basel). 2023 Aug 26;13(17):2767.
- 6) Kanno T, Katano T, Shimura T, Nishigaki R, Kojima Y, Sasaki M, et al. Characteristic endoscopic findings of gastrointestinal malignant lymphomas other than mucosa-associated lymphoid tissue lymphoma. Acta Gastroenterol Belg. 2022 Jul-Sep;85(3):477-483.
- 7) Alvarez-Lesmes J, Chapman J.R, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery E.A, et al. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 1 December 2021; 145 (12): 1585–1596.
- 8) Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, et al. Endoscopic features of gastro-intestinal lymphomas: from diagnosis to follow-up. World J Gastroenterol. 2014 Sep 28;20(36):12993-3005.
- 9) Olszewska-Szopa M, Wróbel T. Gastrointestinal non-Hodgkin lymphomas. Adv Clin Exp Med. 2019 Aug;28(8):1119-1124.
- 10) Swerdlow SH CE, Harris NL, Jaffe ES, Pileri SA, Stein H. WHO classification of tumours of haematopoietic and lymphoid tissues-Revised 4th edition. World Health Organization Classification of Tumours. 2017.
- 11) Hanafy AK, Morani AC, Menias CO, Pickhardt PJ, Shaaban AM, Mujtaba B, et al. Hematologic malignancies of the gastrointestinal luminal tract. Abdom Radiol (NY). 2020 Oct;45(10):3007-3027.
- 12) Pizzi M, Sabattini E, Parente P, Bellan A, Doglioni C, Lazzi S. Gastrointestinal lymphoproliferative lesions: a practical diagnostic approach. Pathologica. 2020 Sep;112(3):227-247.
- 13) Harlendea NJ, Harlendo K. Ki-67 as a Marker to Differentiate Burkitt Lymphoma and Diffuse Large B-cell Lymphoma: A Literature Review. Cureus. 2024 Oct 23;16(10):e72190.
- 14) Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004 Jan 1;103(1):275-82.
- 15) Meyer PN, Fu K, Greiner TC, Smith LM, Delabie J, Gascoyne RD, et al. Immunohistochemical methods for predicting cell of origin and survival in patients with diffuse large B-cell lymphoma treated with rituximab. J Clin Oncol. 2011 Jan 10;29(2):200-7.
- 16) Gualco G, Bacchi LM, Domeny-Duarte P, Natkunam Y, Bacchi CE. The contribution of HGAL/GCET2 in immunohistological algorithms: a comparative study in 424 cases of nodal diffuse large B-cell lymphoma. Mod Pathol. 2012 Nov;25(11):1439-45.
- 17) Hu S, Xu-Monette ZY, Balasubramanyam A, Manyam GC, Visco C, Tzankov A, et al. CD30 expression defines a novel subgroup of diffuse large B-cell lymphoma with favorable prognosis and distinct gene expression signature: a report from the International DLBCL Rituximab-CHOP Consortium Program Study. Blood. 2013 Apr 4;121(14):2715-24.
- 18) Peña C, Villegas P, Cabrera ME. Double or triple-expressor lymphomas: prognostic impact of immunohistochemistry in patients with diffuse large B-cell lymphoma. Hematol Transfus Cell Ther. 2020 Apr-Jun;42(2):192-193.
- 19) Shirwaikar Thomas A, Schwartz M, Quigley E. Gastrointestinal lymphoma: the new mimic. BMJ Open Gastroenterol. 2019 Sep 13;6(1):e000320.
- 20) Matysiak-Budnik T, Priadko K, Bossard C, Chapelle N, Ruskoné-Fourmestraux A. Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist's Point of View. Cancers (Basel). 2023 Jul 27;15(15):3811.
- 21) Cheah CY, Seymour JF. Marginal zone lymphoma: 2023 update on diagnosis and management. Am J Hematol. 2023 Oct;98(10):1645-1657.
- 22) Xia Y, Ge J, Sun Z, Nan F, Wan W, Xu D, et al. CD5-positive marginal zone lymphoma: Clinicopathological features and survival outcomes. Leuk Res. 2022 Jun;117:106840.
- 23) Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol. 2019 Jun;94(6):710-725.
- 24) Nguyen V, Nguyen B, Petris GD, Nguyen C. Education and imaging. Gastrointestinal: gastrointestinal involvement of mantle cell lymphoma. J Gastroenterol Hepatol. 2012 Mar;27(3):617.
- 25) Li S, Xu J, You MJ. The pathologic diagnosis of mantle cell lymphoma. Histol Histopathol. 2021 Oct;36(10):1037-1051.
- 26) Al-Mansour M. Treatment Landscape of Relapsed/Refractory Mantle Cell Lymphoma: An Updated Review. Clin Lymphoma Myeloma Leuk. 2022 Nov;22(11):e1019-e1031.
- 27) Iwamuro M, Tanaka T, Okada H. Review of lymphoma in the duodenum: An update of diagnosis and management. World J Gastroenterol. 2023 Mar 28;29(12):1852-1862.
- 28) Fischer L, Dreyling M. Follicular lymphoma: an update on biology and optimal therapy. Leuk Lymphoma. 2023 Apr;64(4):761-775.
- 29) Takata K, Sato Y, Nakamura N, Tokunaka M, Miki Y, Yukie Kikuti Y, et al. Duodenal follicular lymphoma lacks AID but expresses BACH2 and has memory B-cell characteristics. Mod Pathol. 2013;26(1):22-31.
- 30) Roschewski M, Staudt LM, Wilson WH. Burkitt's Lymphoma. N Engl J Med. 2022 Sep 22;387(12):1111-1122.
- 31) López C, Burkhardt B, Chan JKC, Leoncini L, Mbulaiteye SM, Ogwang MD, et al. Burkitt lymphoma. Nat Rev Dis Primers. 2022 Dec 15;8(1):78.
- 32) Chong Y, Kim TE, Cho U, Jin MS, Yim K, Thakur N, et al. Comparison of Ki-67 Labeling Index Patterns of Diffuse Large B-Cell Lymphomas and Burkitt Lymphomas Using Image Analysis: A Multicenter Study. Diagnostics (Basel). 2021 Feb 19;11(2):343.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 22 Haziran 2025 |
| Yayımlanma Tarihi | 23 Haziran 2025 |
| Gönderilme Tarihi | 2 Şubat 2025 |
| Kabul Tarihi | 24 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 26 Sayı: 2 |
