Brief Article
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World J Gastroenterol. Sep 14, 2013; 19(34): 5727-5731
Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5727
Clonal immunoglobulin heavy chain and T-cell receptor γ gene rearrangements in primary gastric lymphoma
Guo-Dong Shan, Feng-Ling Hu, Ming Yang, Hong-Tan Chen, Wen-Guo Chen, Yun-Gui Wang, Li-Hua Chen, You-Ming Li, Guo-Qiang Xu
Guo-Dong Shan, Feng-Ling Hu, Ming Yang, Hong-Tan Chen, Wen-Guo Chen, Yun-Gui Wang, Li-Hua Chen, You-Ming Li, Guo-Qiang Xu, Department of Gastroenterology, the First Affiliate Hospital, School of Medicine, Zhejiang University, Hangzhou 321000, Zhejiang Province, China
Author contributions: Xu GQ and Li YM designed the research; Shan GD, Hu FL, Chen HT, Wang YG and Chen LH performed the research; Yang M contributed new reagents and analytic tools; Chen WG analyzed the data; Shan GD wrote the paper.
Supported by The Scientific Research Foundation of the Ministry of Health, China, the Medical and Health Science Foundation, Zhejiang Province, China, No. WKJ-2009-2-021
Correspondence to: Dr. Guo-Qiang Xu, Department of Gastroenterology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qing Chun Road 79, Hangzhou 321000, Zhejiang Province, China. xgqhangzhou@163.com
Telephone: +86-571-87236718 Fax: +86-571-87236718
Received: May 18, 2013
Revised: July 24, 2013
Accepted: August 4, 2013
Published online: September 14, 2013
Abstract

AIM: To study the diagnostic value of immunoglobulin heavy chain (IgH) and T-cell receptor γ (TCR-γ) gene monoclonal rearrangements in primary gastric lymphoma (PGL).

METHODS: A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011. The patients were divided into three groups (a PGL group, a gastric linitis plastica group, and a benign gastric ulcer group) based on the pathological results (gastric mucosal specimens obtained by endoscopy or surgery) and follow-up. Endoscopic ultrasonography (EUS) and EUS-guided biopsy were performed in all the patients. The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.

RESULTS: EUS and EUS-guided biopsy were successfully performed in all 48 patients. In the PGL group (n = 21), monoclonal IgH gene rearrangements were detected in 14 (66.7%) patients. A positive result for each set of primers was found in 12 (57.1%), 8 (38.1%), and 4 (19.0%) cases using FR1/JH, FR2/JH, and FR3/JH primers, respectively. Overall, 12 (75%) patients with mucosal-associated lymphoid tissue lymphoma (n = 16) and 2 (40%) patients with diffuse large B-cell lymphoma (n = 5) were positive for monoclonal IgH gene rearrangements. No patients in the gastric linitis plastica group (n = 17) and only one (10%) patient in the benign gastric ulcer group (n = 10) were positive for a monoclonal IgH gene rearrangement. No TCR-γ gene monoclonal rearrangements were detected. The sensitivity of monoclonal IgH gene rearrangements was 66.7% for a PGL diagnosis, and the specificity was 96.4%. In the PGL group, 8 (100%) patients with stage IIE PGL (n = 8) and 6 (46.1%) patients with stage IE PGL (n = 13) were positive for monoclonal IgH gene rearrangements.

CONCLUSION: IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.

Keywords: Immunoglobulin heavy chain, T-cell receptor γ, Gene rearrangement, Primary gastric lymphoma, Endoscopic biopsy specimen

Core tip: In 2003, a new primer system was successfully developed and standardized for the detection of clonally rearranged immunoglobulin (Ig) and T-cell receptor (TCR) genes. This study was a prospective analysis of Ig heavy chain (IgH) and TCR-γ gene rearrangements using the new primer system and endoscopic biopsy specimens from patients with suspected primary gastric lymphoma (PGL). Our study revealed that the detection of monoclonal IgH gene rearrangements is useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica. Monoclonal IgH gene rearrangements may be associated with PGL staging. The sensitivity and the specificity of IgH gene rearrangements for the diagnosis of PGL were 66.7% and 96.4%, respectively.