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Diagnosis, treatment decisions, and follow up in primary gastric lymphoma
  1. H Boot,
  2. D de Jong
  1. Department of Gastroenterology and Pathology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
  1. Correspondence to:
    Dr H Boot;
    h.boot{at}nki.nl

https://doi.org/10.1136/gut.51.5.621

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    Endoscopic ultrasound is inferior to histology for follow up of patients with primary gastric lymphoma after organ conserving strategies

    In this issue of Gut, Püspök and colleagues1 highlight the follow up in patients with primary gastric lymphoma after various stomach conserving therapies: Helicobacter pylori eradication, chemotherapy, radiotherapy, or combinations thereof [see page 691]. Endoscopic ultrasound (EUS) findings were compared with histology and showed that a complete histological remission occurred earlier and more often than an EUS defined remission. Were these results to be expected when treatment response is followed? What are the implications of this study for daily practice?

    In the recently formalised WHO classification,2 gastric lymphoma is considered as the “disease entity” of marginal zone lymphoma (mucosa associated lymphoid tissue (MALT)-type) with a characteristic morphological spectrum, immunological marker pattern, and discriminative chromosomal aberrations. In the past, these lymphomas were often described as low grade (gastric) MALT lymphomas. High grade (MALT) lymphomas are not a separate entity in the WHO classification but are classified as diffuse large B cell lymphomas (DLBCL) with or without areas of marginal zone lymphoma of the MALT type.

    Clinical presentation and endoscopic findings in primary gastric lymphoma may mimic benign and other malignant gastric disorders. The diagnosis of lymphoma can be established on endoscopic biopsies in more than 90% of patients but exact subtyping of the …

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