Clinicopathologic features of surgically resected primary gastric lymphoma

Table 1 Musshoff’s modified Ann-Arbor stage

Stage	Definition
Ie	Involvement of a single extralymphatic organ or site1
Ie1	Involvement of mucosa or submucosa
Ie2	Involvement of more than submucosa
IIe	Involvement of two or more lymph node regions on the same side of the diaphragm
	with localized involvement of an extralymphatic organ and site1,2
IIe1	Involvement of regional lymph nodes
IIe2	Involvement of other lymph nodes beyond regional area
IIIe	Localized involvement of a single extralymphatic organ or site with involvement of lymph node regions on
	both sides of the diaphragm (IIIe) or involvement of the spleen (IIIs) or both (IIIe+s)1,2
IVe	Involvement of extranodal site(s) beyond that designated as “e” more than one extranodal
	deposit at any location, any involvement of liver or bone marrow1,2
E	localized, solitary involvement of extralymphatic tissue, excluding liver and bone marrow
1	Direct spread of a lymphoma into adjacent tissues or organs does not influence stage. Multifocal involvement of a single extralymphatic organ is classified as stage IE and not stage IV. Involvement of two or more segments of the gastrointestinal tract, isolated and not in continuity, is classified as stage IV (disseminated involvement of one or more extralymphatic organs).
2	The definitions of regional lymph nodes for individual sites of extranodal lymphomas are identical to the definitions of regional lymph nodes for individual sites of gastrointestinal carcinomas. For example, the regional lymph nodes for a primary gastric lymphoma are the perigastric nodes along the lesser and greater curvatures and the nodes located along the left gastric, common hepatic, splenic, and celiac arteries.

Table 2 Age and sex distribution of patients

	LG group	HG group	Total	P-value
n (%)	201 (35.1)	37 (64.9)	57
Age (±SD)	52.6 (±11.4)	57.7 (±13.9)	55.9 (±13.2)	n.s.
Sex	10:10	20:17	30:27	n.s.
(M:F)	(1:1)	(1.18:1)	(1.11:1)

LG group: patients with low grade MALT lymphoma, HG group: patients with high grade MALT lymphoma or diffuse large B cell lymphoma.

¹In 1 case: associated with AGC.

Table 3 Presenting symptoms and duration

Symptom	n (%)
Epigastric pain, discomfort	39 (68.4)
Gastrointestinal bleeding	9 (15.8)
Weight loss	9 (15.8)
Indigestion	7 (12.3)
Nausea/vomiting	4 (7.0)
Anorexia	4 (7.0)
Diarrhea	2 (3.5)
Others	3 (5.3)
No Symptom	6 (10.5)
Histopathology	Duration of symptom
LG group	11.9 ± 24.9
HG group	5.2 ± 9.0
Total	7.6 ± 16.7 mo
P = n.s.

Table 4 Preoperative endoscopic findings and diagnosis accuracy

	LG group (%)	HG group (%)	Total (%)
Lymphoma	6 (37.5)	10 (33.3)	16 (34.8)
AGC	4 (25.0)	17 (56.7)	21 (45.7)
EGC	5 (31.3)	2 (6.7)	7 (15.2)
Benign ulcer	1 (6.3)	1 (3.3)	2 (4.3)
Total	16 (100)	30 (100)	46 (100)
Dx. Rate		Lymphoma/total (%)
Primary Dx	6/16 (37.5)	10/30 (33.3)	16/46 (34.8)
D/Dx	8/16 (50.0)	15/30 (50.0)	23/46 (50.0)

Dx: Diagnosis, D/Dx: Differential diagnosis.

Table 5 Comparison between gastroscopic biopsy and post-operative histopathology

Postop.	LG group (%)	HG group (%)	Total (%)
Preop.
LG group	15 (78.9)	4 (21.1)	19 (100.0)
HG group	2 (7.4)	25 (92.6)	8 (100.0)
Total	17	29	46

Table 6 Operation methods

	LG group (%)	HG group (%)	Total (%)
Subtotal gastrectomy	10 (50.0)	21 (56.8)	30 (52.6)
Other partial gastrectomy	2 (10.0)	3 (8.1)	5 (8.8)
Total gastrectomy	8 (40.0)	14 (37.8)	22 (38.6)
TG	7 (35.0)	8 (21.6)	15 (26.3)
TG + splenectomy	1 (5.0)	6 (16.2)	7 (12.3)
Total	20 (100)	37 (100)	57 (100)

P = n.s., TG: total gastrectomy.

Table 7 Location of lesions

	LG group (%)	HG group (%)	Total (%)
Lower 1/3	7 (35.0)	19 (51.4)	26 (45.6)
Middle 1/3	8 (40.0)	10 (27.0)	18 (31.6)
Upper 1/3	3 (15.0)	5 (13.5)	8 (14.0)
Lower + middle	2 (10.0)	2 (5.4)	4 (7.0)
Lower + upper	0 (0.0)	1 (2.7)	1 (1.8)
Total	20 (100)	37 (100)	57 (100)

Table 8 TNM stage

Stage	LG group (%)	HG group (%)	Total (%)
Ia (+ no residual)	15 (78.9)	7 (18.9)	22 (39.3)
Ib	3 (15.8)	12 (32.4)	15 (26.8)
II	0 (0.0)	11 (29.7)	11 (19.6)
IIIa	0 (0.0)	6 (16.2)	6 (10.7)
IV	1 (5.3)	1 (2.7)	2 (3.6)
Total	191 (100)	37 (100)	56 (100)

¹The information on the LN status of one patient (mucosal lesion) was not available among 20 low grade MALT lym-phoma patients.

Table 9 Musshoff stage

Stage	LG group (%)	HG group (%)	Total (%)
Ie1 (+ no residual)	15 (78.9)	7 (18.9)	22 (39.3)
Ie2	2 (10.5)	15 (40.5)	17 (30.4)
IIe1	1 (5.3)	14 (37.8)	15 (26.8)
IIe2	1 (5.3)	1 (2.7)	2 (3.6)
Total	191 (100)	37 (100)	56 (100)

¹The information on the LN status of one patient (mucosal lesion) was not available among 20 low grade MALT lym-phoma patients.

Table 10 Number of lesions

Number	LG group (%)	HG group (%)	Total (%)
None or single	17 (85.0)	29 (83.3)	46 (80.7)
0	1 (5.0)	1 (2.7)	2 (3.5)
1	16 (80.0)	28 (75.7)	44 (77.2)
Multiple	3 (15.0)	8 (21.6)	11 (19.3)
2	1 (5.0)	7 (18.9)	8 (14.0)
6	0 (0.0)	1 (2.7)	1 (1.8)
Diffuse	2 (10.0)	0 (0.0)	2 (3.5)
Total	20 (100)	37 (100)	57 (100)

P=n.s.

Table 11 Characteristics of patients whose disease recurred

Sex/age	Op.	Loc.	Size(cm)	N	T	LN	Musshoff stage	Site of recurrence	DFS (mo)	Survival	OS (mo)
F/80	ST	LB	6x3	1	PM	8/26	IIe2	abdominal LN	0.4	Dead1	10.1
M/34	T	MB	8x2.5	1	PM	12/21	IIe1	abdominal LN,	6.6	Dead	9.1
								bone marrow
M/34	ST	MB	2.2x3	1	SS	0/60	Ie2	remnant stomach	7.6	Alive	57.2
F/59	ST	LB	4x3.5	1	SM	0/19	Ie1	paraaortic LN	10.4	Alive	13.4
M/85	ST	MB & LB	4x3	2	PM	0/64	Ie2	chest	18.2	Dead2	42.0
F/55	T	HB	13x10	1	colon,	0/11	Ie2	abdominal LN	26.3	Dead	37.4
					pancreas
M/67	ST	LB	10x8	1	SS	16/53	IIe1	cervical LN	26.8	Dead3	31.6
M/70	ST	MB	3x2	2	SM	5/19	IIe1	unknown3	70.4	Dead	70.6
			1.5x0.8

Op.: operation method, (ST: subtotal gastrectomy, T: total gastrectomy), Loc: location (LB: lower body, MB: midbody, HB: high body), T: T-stage (SM: submucosa, PM: proper muscle, SS: subserosa), LN: lymph nodes(positive nodes/resected nodes), DFS: disease free survival, OS: overall survival,

¹: pneumonia,

²: medullary infarct,

³: diagnosed in other hospital. Recurred site is uncertain.