P-107 Epidemiology of lymphomas involving the gastro intestinal tract: a multi center retrospective study from South Indian continent

Abstract

Introduction: Gastro intestinal ( GI ) tract may be either primarily or secondarily involved by lymphoma. Primary GI involvement constitutes only 1 % of all lymphomas.We analyzed the epidemiology and clinicopathological profile of patients with lymphoma involving the GI tract. Methods: A retrospective analysis of medical records of patients diagnosed with lymphoma between January 2009 and Dec 2015 were analyzed. Age, sex, site, tumour stage, associated pathological features like intestinal metaplasia (IM), lympho-epithelial lesion (LEL), enteropathy changes and atrophic gastritis (AG) were analysed. Immunohistochemistry profiles in available cases were noted. The treatment methods and outcomes were also studied. Results: A total of 611 cases of lymphoma were diagnosed over an 8 year period; of which 51 cases had GI tract involvement. Immuno histochemical confirmation was available in 44 cases. Forty one cases (males - 29, females - 12) had primary involvement of GI tract. Among the patients with primary GI lymphoma median age of diagnosis was 46 years (7-70 years). Stomach NHL (n = 19: Diffuse Large B cell NHL (DLBCL) - 14, Maltoma - 3, Burkitt lymphoma -1, Anaplastic large cell lymphoma - 1) was the commonest; Small intestinal lymphoma (n = 15: DLBCL - 8, MALTOMA - 3, EATL = 1, Low grade B NHL - 3) and lymphoma of colon (n = 7: DLBCL - 5, Burkitt lymphoma - 2), contributed the remaining cases. Ten cases (7 males, 3 females) had secondary involvement of GI tract as an extranodal site (T cell Lymphoblastic NHL -1, DLBCL - 7 and Follicular NHL -2). Among the 51 cases, 3 cases had HIV infection. Histological profile revealed LEL in 4/41 cases. Of the 3 patients with AG, 2 had IM, and 1 case had associated H Pylori infection. Giardiasis infection was present in 1 case of duodenal MALTOMA. Of the 41 cases with primary GI NHL, 26 were diagnosed after a complete surgery. After staging 7 were staged IE, 14 stage IIE and 4 - stage IV. Treatment: Stomach NHL received chemotherapy (14), radiotherapy (2) and H. Pylori treatment (3); all remaining cases received chemotherapy. Among 39 evaluable patients; 2 patients with stomach maltoma required re treatment with H. Pylori medication, which subsequently cleared. Thirty seven cases (stomach NHL- 18; small intestinal NHL-13 and colonic NHL-6) are alive and disease free at last follow up. Conclusion: Gastrointestinal involvement occurs in less than 10% of cases of lymphoma, primary involvement of only GI tract without other systemic disease is still less common. There was a male preponderance and stomach was the commonest site of primary GI lymphoma, with diffuse large B cell NHL constituting majority of this group. Rare variants of NHL like ALCL were also observed. Surgical resection in intestinal NHL can save patients from perforations. Over 90% of the cases of primary GI lymphomas are alive and healthy at last follow up.