and HBeAg(-) patients - World Journal of Gastroenterology

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Table 1 Expression of common markers and translocations in histological subtypes of gastrointestinal lymphomas Type CD5 CD10 CD19 CD20 CD22 CD23 CD43 CD79a CD3 CD7 CD4 CD8 CD30 CD15 CD45RO Additional features Diffuse large B-cell lymphoma -(+) -(+) + + + - - + - - - - -(+) - -(+) Bcl-6+(-), Bcl-2+(-), t (14;18), t (3;14), t (8;14) MALT lymphoma - - + + + - -(+) + - - - - - - -(+) t (11;18), t (14;18), t (1;14), t (3;14) Follicular lymphoma - +(-) + + + -(+) - + - - - - -(+) - - Bcl-2+, Bcl-6+, t (14;18) Burkitt lymphoma - + + + + -(+) + + - - - - - - - C-myc, t (8;14) Mantle cell lymphoma + - + + + - + + - - - - - - - Cyclin D1+, t (11;14) Peripheral T-cell lymphoma-unspecified +(-) -(+) - - - - +(-) - +(-) -(+) +(-) -(+) -(+) -(+) -(+) - Extranodal NK/T cell lymphoma of patients with esophageal lymphoma include dysphagia, odynophagia, weight loss, chest pain or present as a result of complications such as hemorrhage, obstruction or perforation with a tracheoesophageal fistula. Constitutional B symptoms (fever, night sweats) are not typically present. Almost all cases of primary esophageal lymphoma are DLBCLs with positive surface markers of tumor cells on immunofluorescent staining for immunoglobulin G and κ light chain. MALT lymphoma of the esophagus, however, unlike that of stomach, is not associated with H. pylori. HL of the esophagus is extremely rare. Follicular lymphoma affecting the esophagus is a part of multifocal presentation in the gastrointestinal tract. Radiological and endoscopic findings in esophageal lymphoma vary greatly and are nonspecific, which poses diagnostic challenges when it is differentiated from other benign and malignant lesions. Radiographic patterns of esophageal lymphoma, described in the literature [18-20] , include stricture, ulcerated mass, multiple submucosal nodules, varicoid pattern, achalasia-like pattern, progressive aneurysmal dilatation, and tracheoesophageal fistula formation, and none of them is diagnostic. The morphological features seen at endoscopy are nodular, polypoidal, ulcerated or stenotic [21] . EUS has gained clinical acceptance for the assessment of lymphoma and preoperative staging, because it can accurately depict the structural abnormalities and depth of invasion of the lesions. EUS findings, however, are not pathognomonic, with presentation varied as anechoic, hypoechoic or even hyperechoic masses [22] . CT findings in esophageal lymphoma are nonspecific and not diagnostic, with features such as thickening of the wall mimicking other common tumors, such as esophageal carcinoma. CT, however, they are valuable for the evalua- WJG|www.wjgnet.com Ghimire P et al . Primary GI lymphoma -(+) - - - - - + - -(+) +(-) -(+) - -(+) -(+) - EBV+, gains of 2q, 15q, 17q, 22q, losses of 6q, 8p, 11q, 12q, 13q EATL - - - - - - +/- - + + -(+) +(-) +(-) - +(-) TIA1+, gains of 1q, 5q, 7q, 9q, losses of 8p, 9p, 13q Hodgkin disease +(-) - - -(+) - - - -(+) +(-) -(+) - - +(-) +(-) -(+) Variable +: ≥ 90% positive; +(-): > 50% positive; -(+): < 50% positive; -: < 10% positive cases. MALT: Mucosa-associated lymphoid tissue; EATL: Enteropathy-associated T-cell lymphoma; EBV: Epstein-Barr virus. tion of the extraluminal component of esophageal mass, its mediastinal extension, fistula formation, and status of lymph nodes, thus playing a role in staging disease, assisting in stratification of available treatment modalities, evaluating treatment responses, monitoring disease progression, and detecting relapses [23] . Recently, incorporation of PET/CT has emerged as an indispensable tool in staging the disease and following up the patients with extranodal involvement of Hodgkin’s and non-Hodgkin’s lymphoma, with an increased sensitivity and specificity. Diffuse large B-cell non-Hodgkin lymphoma of the esophagus is manifested as circumferential thickening of the wall, with diffuse increased FDG uptake. However, the intensity of FDG uptake in lymphoma is influenced by various intrinsic tumor factors such as histological features and grade, as well as various extrinsic factors. FDG PET/CT can also detect the indolent lesions that are undetectable on conventional cross-sectional imaging [24] . Gastric lymphoma Stomach is the most commonly involved site (60%-75%) in gastrointestinal tract followed by small bowel, ileocecal region and rectum [25] . Gastric lymphoma accounts for 3%-5% of all malignant tumors of the stomach [26] . Although the incidence of gastric carcinoma has been reduced, the incidence of primary gastric lymphoma is increasing [27] . H. pylori play a role in the development of most MALT lymphomas. However, its exact mechanism has not been fully understood, although a chronic inflammation may enhance the probability of malignant transformation via B cell proliferation in response to H. pylori mediated by tumor-infiltrating T cells [28] . H. pylori may play a similar role in development of DLBCL and few studies have shown 699 February 14, 2011|Volume 17|Issue 6|
Ghimire P et al . Primary GI lymphoma Table 2 Characteristic features of gastrointestinal lymphomas Region Age (yr) GIL (%) complete remission after eradication therapy alone [28] . It has been shown that individuals with positive HBsAg have an increased risk of developing NHL [29] . It was reported that HBV plays a role in the development of B-cell NHL [30] . In contrast, primary gastric lymphoma with a T-cell phenotype is relatively rare, accounting for only 7% of primary gastric lymphomas in HTLV-1 infected endemic areas and a relatively large number of such cases are secondary gastric involvement of adult T-cell leukemia. Primary gastric T-cell lymphoma without HTLV-1 infection is rare, and sporadic cases have been reported [31] . The age of most gastric lymphoma patients is over 50 years with a relative predilection in males. Clinical symptoms of gastric lymphoma are nonspecific and indistinguishable from other benign and malignant conditions. The most common complaints of gastric lymphoma patients are epigastric pain, weight loss, nausea and vomiting. Occasionally, an abdominal mass is palpable. Lymphadenopathy is rare and its patients often have no physical signs. Perforation, bleeding, or obstruction is very uncommon. Unlike nodal lymphoma, B constitutional symptom is not common. Although all histological kinds of nodal lymphoma can arise from the stomach, the majority of them are of the B-cell origin, and MALT lymphoma and DLBCL ac- WJG|www.wjgnet.com Sex Predilection site Oropharyngeal > 50 - M > F Tonsil, nasopharynx 1 , base of tongue Esophagus Variable < 1 - Mid and lower third Etiological/ risk factors Stomach > 50 60-75 M > F Antrum H. pylori (MALT lymphoma), HTLV-1, HBV (DLBCL), EBV, HCV Small intestine Variable 20-30 Usually, M > F Ileum, jejunum, duodenum, multiple sites Colon/rectum 50-70 6-12 M > F Caecum, ascending colon, rectum Presenting symptoms Common pathological subtypes EBV Dysphagia, dyspnea, painless mass, ulcer, oral/ hearing pain, B symptoms rare DLBCL, EMZL/ MALT, PTCL, FL, MCL, ENKL, HD EBV, HIV Dysphagia, odynophagia, DLBCL, MALT weight loss, epigastric/ lymphoma, HD, MCL, chest pain, pneumonia, bleeding rare, B symptoms rare T-cell lymphoma Celiac disease (EATL), C. jejuni (IPSID), EBV, HIV/ AIDS Celiac disease (EATL), EBV, H. pylori (MALT lymphoma) Epigastric pain, dysphagia, nausea, vomiting, weight loss, abdominal mass, gastrointestinal bleeding, obstruction, perforation, B symptoms rare Abdominal pain, nausea, vomiting, weight loss, GI bleeding, obstructive symptoms, intussusceptions, perforation, diarrhea (in IPSID), B symptoms rare Abdominal pain, weight loss, abdominal mass, lower GI bleeding, obstruction, perforation Radiographic features Lobular mass, ulcers Stricture, ulcerated mass, submucosal nodules, varicoidlike, achalasia-like, aneurysmal, fistula formation DLBCL, MALT, PTCL Ulcers, polypoid mass, thickened fold, mucosal nodularity, linitis plastica-like DLBLCL, MALT, EATL, MCL, Burkitt lymphoma, FL, IPSID, PTCL, ENKL DLBCL, MALT, EATL, MCL, PTCL, Burkitt lymphoma Polypoid mass, multiple nodules, infiltrative form, ulcer, excavation, fistulization, extraluminal mass, mucosal thickening, strictures Polypoid mass, ulcers, mucosal nodularity, cavitary mass, mucosal thickening, strictures, aneurysmal 1 Included here though usually not applicable. GIL: Gastrointestinal lymphoma; EBV: Epstein Barr virus; DLBCL: Diffuse large B cell lymphoma; EMZL: Extranodal marginal-zone lymphoma; PTCL: Peripheral T cell lymphoma; FL: Follicular lymphoma; EATL: Enteropathy-associated T-cell lymphoma; MCL: Mantle cell lymphoma; IPSID: Immunoproliferative small intestinal disease; HD: Hodgkin’s disease; HTLV-1: Human T-cell lymphotropic virus-1; HCV: Hepatitis C virus; HBV: Hepatitis B virus; H. pylori: Helicobacter pylori; C. jejuni: Campylobacter jejuni; HIV: Human immunodeficiency virus; AIDS: Acquired immune deficiency syndrome; ENKL: Extranodal NK/T-cell lymphoma. count for over 90%. MALT lymphoma comprises up to 50% of all primary lymphomas involving the stomach. Histologically, the most significant finding is the presence of a variable number of lymphoepithelial lesions defined by evident invasion and partial destruction of mucosal glands by the tumor cells. MALT lymphoma shows the immunophenotype of B cells in the normal marginal zone of spleen, Peyer’s patches and lymph nodes. The tumor B-cells can express the surface immunoglobulin and pan-B antigens (CD19, CD 20, and CD79a), the marginal zone-associated antigens (CD35 and CD21, and lack CD5, CD10, CD23) and cyclin D1. MALT lymphoma can be divided into H. pylori positive or negative based on the presence of H. pylori. H. pylori negative MALT lymphoma tends to have a higher positive rate for t (11;18) (q21;q21) translocation than H. pylori positive MALT lymphoma [32] . DLBCL, a heterogeneous group of tumors which are clinically, histologically, immunophenotypically, cytogenetically variable, can be divided into 3 subgroups, namely germinal-center B-cell-like, activated B-cell-like, and primary mediastinal DLBCL according to the gene expression patterns with each having a different prognostication. The most commonly seen translocations as mentioned earlier include t (14;18) (q32;q21) with BCL2-rearrange- 700 February 14, 2011|Volume 17|Issue 6|
Page 1 and 2: World Journal of Gastroenterology W
Page 3 and 4: Robert JL Fraser, Daw Park Jacob Ge
Page 5 and 6: Italy Donato F Altomare, Bari Piero
Page 7 and 8: Fernando Azpiroz, Barcelona Ramon B
Page 9 and 10: S Contents EDITORIAL REVIEW ORIGINA
Page 11 and 12: Contents ACKNOWLEDGMENTS APPENDIX A
Page 13 and 14: Jahn KA et al . Colon cancer and li
Page 23 and 24: Săftoiu A. Imaging techniques in E
Page 29: Ghimire P et al . Primary GI lympho
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Page 39: Online Submissions: http://www.wjgn
Page 42 and 43: Table 2 Comparison of hepatitis B e
Page 45 and 46: Utama A et al . HBV core promoter m
Page 47 and 48: Utama A et al . HBV core promoter m
Page 49 and 50: Motoki T et al . Glutamine depletio
Page 51 and 52: Table 2 Nutrient composition of mou
Page 53 and 54: A Motoki T et al . Glutamine deplet
Page 55 and 56: A Counts B % of sub-G0 cell populat
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Page 59 and 60: Hu JD et al . Urinary metabolomic p
Page 61 and 62: Abundance/× 10 6 Abundance/× 10 6
Page 63 and 64: A Regression factor scores 2 for an
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Page 67: Fu JF et al . NAFLD and metabolic s
Page 70 and 71: developing hypertension (OR: 2.18,
Page 72 and 73: obese and exhibited higher insulin
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Page 77 and 78: Roberts SE et al . Perinatal factor
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Oksaharju A et al . Probiotics regu
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Factors associated with improved su
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Koehler-Santos P et al . Identifica
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Koehler-Santos P et al . Identifica
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Goenka MK et al . Capsule endoscopy
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Tatsuki M et al . Hypermagnesemia a
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Chang CC et al . Parity and gastric
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Chang CC et al . Parity and gastric
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Zhang XQ et al . EEA model of guine
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Table 3 Measurement of common bile
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Zhang XQ et al . EEA model of guine
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Zhao R et al . Gene expression anal
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Zhao R et al . Gene expression anal
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Qiu HB et al . HBV infection and li
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Qiu HB et al . HBV infection and li
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Shen H et al . K-ras and BRAF mutat
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