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Radiographic Findings of Primary B-Cell Lymphoma of the Stomach: Low-Grade Versus High-Grade Malignancy in Relation to the Mucosa-Associated Lymphoid Tissue Concept

¹ Department of Diagnostic Radiology, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-Ku, Seoul 120-752, Korea.
² YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270, Korea.
³ Department of Pathology, Yonsei University College of Medicine, Seoul 120-752, Korea.
⁴ Department of Diagnostic Radiology, Ajou University College of Medicine, Suwon, Kyounggi-Do, Korea.

OBJECTIVE. We undertook this study to assess how well double-contrast radiography and CT allow radiologists to differentiate low-grade from high-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach.

MATERIALS AND METHODS. We retrospectively reviewed the upper gastrointestinal radiographs and contrast-enhanced CT scans of 57 patients with pathologically proven primary gastric lymphoma (low-grade [n = 29] and high-grade [n = 28] MALT lymphoma).

RESULTS. On upper gastrointestinal radiography, ulceration (39%) was the most common finding in low-grade lymphoma, whereas polypoid appearance (38%) was the most common in high-grade lymphoma. In the 29 patients (33 lesions) with low-grade MALT lymphoma, upper gastrointestinal radiography revealed 13 ulcerative lesions (39%), 10 nodular lesions (30%), four infiltrative lesions (12%), two polypoid lesions (6%), and four combined lesions (12%). In the 28 patients (29 lesions) with high-grade lymphoma, upper gastrointestinal radiography revealed 11 polypoid lesions (38%), nine infiltrative lesions (31%), six ulcerative lesions (20%), one nodular lesion (3%), and two combined lesions (7%). On CT, thickening of the gastric wall in low-grade lymphoma (range, 0.3-2.5 cm; mean, 0.8 cm) was much less than that in high-grade lymphoma (range, 0.7-8.0 cm; mean, 2.5 cm). Abdominal lymphadenopathy was less frequent in low-grade lymphoma (14%) than in high-grade lymphoma (75%).

CONCLUSION. Most low-grade lymphomas show superficial spreading lesions, such as mucosal nodularity, shallow ulcer, and minimal fold thickening, on upper gastrointestinal radiography, whereas most high-grade lymphomas show mass-forming lesions or severe fold thickening.

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				S. Ghai, J. Pattison, S. Ghai, M. E. O'Malley, K. Khalili, and M. Stephens Primary Gastrointestinal Lymphoma: Spectrum of Imaging Findings with Pathologic Correlation RadioGraphics, September 1, 2007; 27(5): 1371 - 1388. [Abstract] [Full Text] [PDF]