Primary gastrointestinal lymphoma

We studied 56 patients with primary gastrointestinal lymphoma to determine the manifestations, diagnostic and treatment methods, and patient outcomes. We identified 27 cases of primary gastric lymphoma and 29 cases of lymphoma involving the remainder of the gastrointestinal tract. Initial symptoms were nonspecific and included abdominal pain, weight loss, nausea, and vomiting. Diagnosis was frequently made at operation, with less than half of the patients having endoscopy and biopsy. The predominant histologic type was diffuse histiocytic lymphoma; the second most common type was poorly differentiated lymphocytic lymphoma. Average survival for patients with gastric lymphomas was 38 months, versus 21 months for those with intestinal lymphomas. The most important prognostic factor was the stage of disease at presentation; spread beyond the regional lymph nodes was associated with shortened survival. Comparison of treatment groups was compromised by the varied combinations of therapy used and by the stages and sites of disease. This study points out the need for prospective randomized clinical trials, with comprehensive staging and uniform therapeutic procedures, to identify the best available methods.