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Pathology of Gastric

Lymphoma

Dr Sampurna Roy MD

GI Path Online- Home Page  

Gastric Pathology - Home Page

 

 March 2016

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

- Normal Histology of the Large Intestine

- Interpretation of Large Intestinal Biopsies

- Assessment of abnormalities -1 (lumen, surface epithelium, subepithelial zone)

- Assessment of abnormalities - 2  (crypt density , architecture and epithelium)

- Assessment of abnormalities - 3  (changes in the lamina propria,muscularis mucosae and submucosa)

 

Microscopic/ collagenous colitis ;  

- Pseudo membranous colitis ;

-
Pathology of Amebic Colitis
 ;   

- Gross examination of colorectal resection specimens in  non-neoplastic diseases

Primary malignant lymphoma of the stomach are almost all non Hodgkin's type and of B-cell lineage.

These lymphomas usually arise from MALT (mucosa associated lymphoid tissue)- also known as Marginal Zone B - cell lymphoma (Low and High grade).

Diffuse large B-cell lymphoma include high grade lymphoma of MALT origin and non-MALT type and they are indistinguishable.

Other types include mantle cell lymphoma (malignant lymphomatous polyposis) , follicular lymphoma, Burkitt's lymphoma and rare solitary plasmacytoma.

Helicobacter pylori infection is a risk factor for gastric lymphoma 

Some MALT lymphomas have been reported in immunocompromised patients (in AIDS and following organ transplantation).

High grade lymphoma following organ transplantation may be related to Epstein-Barr virus.

Note: Diagnosis of gastric lymphoma is made on the morphological features.

Lymphoma should not be diagnosed or refuted on the basis of clonality studies by immunohistochemistry or molecular techniques alone.

Gross features:

Commonly located in the gastric antrum.

May be polypoid and fungating like gastric carcinoma.

In low grade cases, multiple erosions or superficial ulceration may be present.

                          
Microscopic features:

Low Grade: 

- Diffuse polymorphous population of B-cells expanding the lamina propria. Reactive lymphoid follicles are present. Numerous plasma cells are also  noted, some of these may have Dutcher bodies (true intranuclear inclusion made up of immunoglobulin).

- Small or medium sized irregular (centrocyte-like) cells forming lymphoeithelial lesions and destroying the epithelium, leaving epithelial remnants and sometimes invading the follicles.

- In some, cases the neoplastic cells resemble small lymphocytes or monocytoid B cells with abundant pale staining cytoplasm.

Note:    

Lymphoepithelial lesions defined as glandular structures expanded and destroyed by groups of more than 3 lymphoid cells.

Immunostaining for CD20, CD79 and cytokeratin are useful for demonstrating lymphoepithelial lesions. CD5, CD10, CD23 or cyclin D1 are negative.

Occasional non destructive lymphoepithelial lesions alone are not sufficient to diagnose lymphoma.

Carefully look for compact clusters, confluent aggregates or sheets of blast cells that makes the tumour high grade.

Problem in distinguishing low grade lymphoma from heavy  chronic inflammatory cell infiltrate in chronic gastritis (lymphoepithelial lesion is diagnostic of lymphoma).

High Grade:

- Lesion does not regress  with H. pylori eradication.

- Destructive infiltrate of clusters or sheets of blast cells.

- Few or no lymphoepithelial lesions.

- Mitoses and apoptotic bodies frequent.

- Problem in distinguishing from diffuse carcinoma, sarcoma, or even T-cell lymphoma or metastatic melanoma. Epithelial lesions infiltrated by melanoma cells may mimick lymphoepithelial lesions.

- Mucin stains and immunostaining for cytokeratin , CEA , common leucocyte antigen, B and T cell markers are very helpful.

                                               
Further reading

Gastric lymphoma: still an interdisciplinary challenge .

Gastric lymphoma: the histology report.

Primary low-grade and high-grade gastric MALT-lymphoma presentation.

Review of the molecular profile and modern prognostic markers for gastric lymphoma: how do they affect clinical practice?

Critical evaluation of Bcl-6 protein expression in diffuse large B cell lymphoma of the stomach and small intestine. 

Regression of high grade mucosa associated lymphoid tissue (MALT) lymphoma after Helicobacter pylori eradication. 

 

GI Path Online- Home Page  

Gastric Pathology - Home Page

 

Normal Histology of Esophagus

An approach to the reporting of esophageal biopsies

Benign tumours and tumour -like conditions of esophagus.

 1. Squamous papilloma of the esophagus

 2.Inflammatory fibroid polyp of the esophagus

 3. Leiomyoma of the esophagus

 4. Granular cell tumour of the esophagus

 5. Esophageal cysts 

 6. Glycogenic acanthosis 

Reporting of esophageal resection specimens

Squamous epithelial dysplasia  including squamous cell carcinoma in-situ of the esophagus

Small cell carcinoma of the esophagus 

Drug related lesions of the gastrointestinal tract.

 

An outline of the anatomy and normal histology of the  stomach for pathologists.

Reporting of gastric biopsies (non-neoplastic gastric lesions).

Pathology and pathogenesis of peptic ulcer.

Acute Gastritis 

Chronic Gastritis

Helicobacter pylori  associated (TypeB)  Gastritis 

Autoimmune Gastritis (Type A) 

Reactive /Reflux/ Chemical Gastritis (Type C)

Lymphocytic Gastritis

Collagenous Gastritis

Granulomatous Gastritis

Eosinophilic Gastritis

Gastric Xanthoma/Xanthelasma

Other Non-Neoplastic Gastric Lesions

Benign tumour and tumour- like lesions

Gastric Lymphoma

Gastric Carcinoid Tumour

Gastrointestinal Stromal Tumour

Gastric Epithelial Dysplasia

Early Gastric Carcinoma

Gross Examination of the Gastrectomy Specimen 

Drug related lesions of the gastrointestinal tract

 

 

 

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