Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Gastric Lymphoma Gastric Stromal Tumor 607

■endoscopy: localize and biopsy for pathology (low-grade B-cell

MALT lymphoma (associated with H. pylori) versus diffuse large B-

cell lymphoma)

differential diagnosis

■adenocarcinoma, Menetrier’s disease, hypertrophic gastropathy,

thickened gastric folds due to infections, reactive lymphoid hyper-

plasia (immunohistochemistry will establish monoclonality of lym-

phocytes)

management

What to Do First

■Stage disease:

■CXR and CT scans: determine distant metastasis

■endoscopic ultrasonography: determine depth and local involve-

ment

specific therapy

■low-grade MALT lymphomas which are H. pylori positive: antibiotic

therapy directed toward H.pylori in early disease; chemotherapy in

advanced disease

■diffuse large-cell B-cell lymphoma: surgery may be useful in early

disease. chemotherapy and radiation therapy in advanced disease

Side Effects & Contraindications

■related to surgery and chemotherapy or radiation.

follow-up

■No standard protocol; similar to gastric adenocarcinoma.

complications and prognosis

■Better for MALT (5-year survival 90%) than large-cell lymphoma

(65%).

■Depends on stage and grade

Gastric Stromal Tumor................................

LYN SUE KAHNG, MD and ROY SOETIKNO, MD, MS

history & physical

■previously called leiomyoma/leiomyosarcoma

Signs & Symptoms

■often asymptomatic especially if less than 2 cm