Gut lymphomas.

Abstract

Gut lymphoma still remains the subject of much debate and controversy with respect to pathological classification, clinical staging and treatment. This is mainly due to the fact that most studies reported retrospective non-randomized evaluations of small series and lacked uniformity in histological classification, patients' characteristics and type of treatment. Moreover, most of the historical series were published before the recognition of MALT as the origin of most GI lymphomas. Hence, there is a compelling need for the use of modern histological criteria for primary GI lymphomas because of their unique histology, special features and origin in mucosal tissue. General adoption of the histological classification proposed in 1988 by Isaacson et al (Table 1) can be recommended which follows the general principles of the Kiel Classification and includes the MALT lymphomas as a particular disease entity. Combination chemotherapy is the treatment of choice for gut lymphomas with aggressive histology and multiple node involvement or disseminated disease. The effectiveness of combination chemotherapy in advanced disease has excited a reconsideration of the role of primary surgery in less advanced cases where surgery has, historically, been the initial procedure of choice. This is particularly true for gastric lymphomas where it is possible that, in future, surgery will be resorted to as a potential approach for salvage when complete remission is not achieved with conservative therapy. For primary intestinal lymphoma, however, there are as yet no studies which clearly demonstrate that surgery is not necessary. With respect to the group of localized low-grade MALT lymphomas of the stomach and the indolent nature of the disease make plausible a conservative approach, with antibiotic eradication of H. pylori as the sole initial treatment. This may avert or at least postpone the indication for surgical resection in the majority of patients.