I. EUS in Advanced CancerEUS in MALT lymphoma☆
Section snippets
The MALT lymphoma concept
Marginal zone lymphomas are divided in nodal, primary splenic, and extranodal lymphomas; the latter derive from the mucosa-associated lymphoid tissue (MALT), and they are the most frequent ones, representing 8% of all non-Hodgkin's lymphomas. They are composed of small B-lymphocytes with centrocytic-, immunocytic- or monocytoid-like appearance and varying degrees of plasmacellular differentiation. MALT lymphoma cells, like marginal zone B-lymphocytes, are CD20+, CD21+, CD35+, IgM+, CD5−, CD10−,
EUS in MALT lymphoma
At the present, EUS is the most accurate imaging modality for evaluation and staging of infiltrative gastric lesions.17, 18, 19, 20, 21, 22, 23
The number of papers on EUS staging of gastric MALT lymphoma, which has been progressively increasing in recent years, seems to confirm EUS superiority over other techniques (Table 1).24Subject categories No. of articles EUS in general 169 Instrumentation 161 Colorectum 117 Esophageal
Italian experience
A total of 76 patients over the age of 18 referred to any one of the 15 participating centers for suspected gastric MALT lymphoma from January 1997 to December 1999 were evaluated.39 Inclusion criteria were as follows: low-grade primary gastric MALT lymphoma stages IE (IE1-IE2) or IIE1 and H pylori positive status. Exclusion criteria were as follows: MALT lymphoma stages IIE2, IIIE, and IVE, prior history of chemotherapy, or HIV-positive status.
All patients underwent baseline endoscopy and
Results
A total of 76 patients with gastric MALT lymphoma and positive H pylori status were evaluated. Twenty-five patients were excluded for various reasons. A subset of 51 patients (31 male, 20 female, median age 63 years, range 21-88 years) met inclusion criteria and formed our study sample.
All 51 patients were in stage T1 or T2, N0 or N1, M0. Two years after therapy, regression of lymphoma was seen in 28 of 51 (55%) patients: 25 patients were H pylori negative and 3 patients remained H pylori
Conclusions
In the past, the combination of upper endoscopy, abdominal US, and CT scan have been used to stage gastric malignancies and had low reported accuracy. The advent of EUS has led to marked improvement in staging accuracy of GI tract lesions. Currently, EUS is the most accurate imaging modality for evaluation and staging of infiltrative gastric lesions. It allows direct visualization of the individual layers of the 5-layer gastric wall and assessment of perigastric structures and lymph nodes.
The
Disclosure
The authors received fundamental financial support from 1473 Fondazione del Monte di Bologna e Ravenna.
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Reprint requests: Professor Giancarlo Caletti, Director GI Unit, University of Bologna, AUSL di Imola, Castel S. Pietro Terme Hospital, Viale Oriani 1, 40024, Castel S. Pietro Terme, Bologna, Italy.