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Gastrointestinal lymphoma is a primary or secondary malignant lymphoid neoplasm involving the GI tract.
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- It is the most common extranodal site of non-Hodgkin’s lymphoma (NHL), accounting for 30–40% of extranodal lymphomas and about 1–4% of all GI malignancies.
- The stomach is the most frequent site, followed by small intestine and colon.
Etiopathogenesis
Histological subtypes:
- Extranodal marginal zone B-cell lymphoma of MALT (mucosa-associated lymphoid tissue):
- Indolent, associated with Helicobacter pylori gastritis in stomach.
- Diffuse large B-cell lymphoma (DLBCL):
- Aggressive, can arise de novo or from transformation of MALT.
- Others: Mantle cell lymphoma, follicular lymphoma, enteropathy-associated T-cell lymphoma (EATL), Burkitt lymphoma, immunoproliferative small intestinal disease (IPSID, Mediterranean lymphoma).
Risk factors:
- H. pylori infection (gastric MALT).
- Chronic inflammation / autoimmune disorders (e.g., celiac disease → EATL).
- Immunodeficiency (HIV, post-transplant).
- Geographic variations (IPSID in Middle East/North Africa).
Pathogenesis:
- Chronic antigenic stimulation → acquired lymphoid tissue in GI mucosa → clonal B/T-cell proliferation → lymphoma.
Clinical Features
| Site |
Clinical features |
| Stomach |
|
| (55–65%) |
• Epigastric pain, dyspepsia, nausea, vomiting, GI bleeding, weight loss. |
| • Less obstructive features compared to adenocarcinoma. |
|
| Small intestine |
|
| (20–30%) |
• Ileum is commonest due to abundant lymphoid tissue. |
| • Abdominal pain, obstruction, intussusception, perforation, malabsorption. |
|
Special entities:
• IPSID (α-chain disease, affects young adults, chronic diarrhea, malabsorption).
• ‣: Associated with celiac disease). |
| Colon/rectum
(10–15%) | Abdominal mass, altered bowel habits, bleeding, sometimes obstruction. |
| Esophagus (rare) | Dysphagia |
- Systemic B-symptoms (fever, night sweats, weight loss) are less common in localized GI lymphoma compared to nodal disease.