Primary and Secondary Hematolymphoid Neoplasms of the Gastrointestinal Tract: A Single Institute Experience.

INTRODUCTION: The gastrointestinal tract is the most common extranodal region for hematolymphoid neoplasms. However, when compared to inflammatory lesions or epithelial tumors, this group of neoplasms is quite rare and some of them cause diagnostic difficulties. In this study, the clinicopathological features of common hematolymphoid neoplasms of the gastrointestinal tract were aimed to be represented and observed rare entities were highlighted.
METHODS: Forty-six patients who were diagnosed of hematolymphoid neoplasia with gastrointestinal system infiltration between the years 2014 and 2021 were selected retrospectively from the archives of pathology department. Pathology reports, demographic and clinical data, endoscopic and imaging findings were collected from the hospital information system.
RESULTS: Thirty-six of the patients were diagnosed of primary neoplasms of the gastrointestinal tract. Nine patients were accepted as secondary spread of systemic disease to the gastrointestinal tract. For one patient, differential diagnosis regarding primary or secondary disease could not be made with available data. The mean age was 56. Approximately three-quarters (73.9%) of the cases were diagnosed by endoscopic biopsy. Patients frequently (73.9%) presented with nonspecific gastrointestinal symptoms. However, ileus was described in cases with bowel localization. The most common diagnosis was diffuse large B-cell lymphoma (n: 26) followed by MALT lymphoma (n: 6). We had four patients diagnosed as duodenal-type follicular lymphoma. Rare cases were IRF4-associated large B-cell lymphoma (n: 1), EBV positive large B cell lymphoma (n: 1), extracavitary/solid variant primary effusion lymphoma (n: 1), myeloid sarcoma (n: 1).
DISCUSSION AND CONCLUSION: An unexpected difference was that the number of patients with diffuse large B-cell lymphoma was more than four times of MALT lymphoma. Possibility of confusion with poorly differentiated carcinomas is an important handicap especially in rare high grade lymphomas and myeloid neoplasms. Duodenal lymphoid follicles should be carefully evaluated and immunohistochemical evaluation should be performed.

Gastrointestinal Sistemin Primer ve Sekonder Hematolenfoid Neoplazileri: Tek Merkez Deneyimi.

GÝRÝÞ ve AMAÇ: Gastrointestinal sistem, hematolenfoid neoplazilerin en sýk görüldüðü ekstranodal bölgedir. Bununla birlikte inflamatuar lezyonlar ve epiteliyal neoplazilere kýyasla oldukça nadir gözlenen bu grup neoplazilerde taný zorluklarý yaþanabilmektedir. Bu çalýþmada gastrointestinal sistemin sýk görülen hematolenfoid neoplazilerinin klinikopatolojik özelliklerini sunmayý, nadir görülen antitelere ise dikkat çekmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Patoloji arþivimizden, 2014-2021 yýllarý arasýnda, gastrointestinal sistem infiltrasyonu ile hematolenfoid neoplazi tanýsý alan 46 hasta retrospektif olarak tespit edilmiþtir. Patoloji raporlarý yaný sýra demografik ve klinik verilere, endoskopi ve görüntüleme bulgularýna hastane bilgi sisteminden ulaþýlmýþtýr.
BULGULAR: Otuzaltý hastada primer odak gastrointestinal sistemdi. Dokuz hastada, gastrointestinal infiltrasyon sistemik hastalýðýn sekonder yayýlýmý olarak kabul edildi. Hastalardan birinde, mevcut verilerle primer veya sekonder hastalýk ayrýmý yapýlamadý. Ortalama yaþ 56 idi. Olgularýn yaklaþýk dörtte üçü (%73,9) endoskopik biyopsi ile taný aldý. Hastalarýn sýklýkla baþvuru sebebi nonspesifik gastrointestinal semptomlardý (%73,9). Barsak yerleþimli orgularda ise ileus tablosu ile karþýlaþýldý. En sýk taný diffüz büyük B hücreli lenfoma (n: 26), ardýndan MALT lenfomaydý (n: 6). Duodenal tip foliküler lenfoma tanýsý alan dört hastamýz mevcuttu. Nadir vakalarýmýz; IRF4 ile iliþkili büyük B hücreli lenfoma (n: 1), EBV pozitif büyük B hücreli lenfoma (n: 1), ekstrakaviter/solid varyant primer efüzyon lenfoma (n: 1), myeloid sarkomdu (n: 1).
TARTIÞMA ve SONUÇ: Difüz büyük B hücreli lenfoma hasta sayýsýnýn MALT lenfomanýn dört katýndan fazla olmasý beklenmeyen bir farktýr. Özellikle nadir görülen yüksek dereceli lenfomalar ve myeloid neoplazilerin, az diferansiye karsinomlarla karýþtýrýlabilme olasýlýðý önemli bir handikaptýr. Duodenal lenfoid foliküller dikkatlice deðerlendirilmeli ve immünhistokimyasal deðerlendirme yapýlmalýdýr.