The gastrointestinal tract (GIT) is the most common anatomic site of extranodal non-Hodgkin lymphoma (NHL) involvement. The classification criteria of lymphoma have changed in recent decades, and few large-sample studies regarding subtype analysis of lymphoma have been performed in this site. Aim: Therefore, the present study was conducted to analyze the histological subtype distribution of the GIT. Method: All patients in a single institution with a diagnosis of primary NHL in the GIT were enrolled between January 2007 and April 2014. The patients were categorized according to the WHO (2008) classification of tumors of hematopoietic and lymphoid tissue. Result: A total of 1,010 eligible cases diagnosed as NHL were collected in this study. The male:female ratio was 1.7:1 and the median age was 55 years. The percent of patients with lymphoma involvement in the stomach was 52% (n = 522), and the remaining 48% (n = 484) had intestinal tract involvement. Histologically, diffuse large B cell lymphoma (DLBCL) was the most common subtype in all of the GIT lymphoma cases, and was also the most common subtype in cases involving the stomach (78%) and the intestinal tract (53%). The incidence of DLBCL and mucosa-associated lymphoid tissue lymphoma in the stomach was significantly higher than the incident in the intestinal tract (p < 0.01). T and NK cell lymphoma was significantly more common in the intestinal tract than in the stomach (p < 0.01). Extranodal NK/T cell lymphoma nasal type (ENKTL-N) was the most common subtype of T and NK cell lineage lymphoma in GIT and was also the second most common intestinal tract-involved lymphoma. Conclusion: DLBCL was the most frequent lymphoma in the stomach and in the intestinal tract. T and NK cell lineage lymphoma had a higher occurrence in the intestinal tract than in the stomach. ENKTL-N was the most frequent subtype of lymphoma derived from NK/T cell lineage, and was the second most common lymphoma among all intestinal tract lymphomas.

Journal Section:
Editor's choice
Keywords:
Diffuse large B cell lymphoma, Extra-nodal NK/T cell lymphoma nasal type, Gastrointestinal tract, Non-Hodgkin lymphoma, WHO classification
1.
Yoon SO, Suh C, Lee DH, Chi HS, Park CJ, Jang SS, Shin HR, Park BH, Huh J: Distribution of lymphoid neoplasms in the Republic of Korea: analysis of 5,318 cases according to the World Health Organization classification. Am J Hematol 2010;85:760-764.
2.
Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS: Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 2006;107:265-276.
3.
Howell JM, Auer-Grzesiak I, Zhang J, Andrews CN, Stewart D, Urbanski SJ: Increasing incidence rates, distribution and histological characteristics of primary gastrointestinal non-Hodgkin lymphoma in a North American population. Can J Gastroenterol 2012;26:452-456.
4.
Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, Delsol G, De Wolf-Peeters C, Falini B, Gatter KC, Grogan TM, Isaacson PG, Knowles DM, Mason DY, Muller-Hermelink H-K, Pileri SA, Piris MA, Ralfkiaer E, Warnke RA: A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994;84:1361-1392.
5.
Chan JKC, Quintanilla-Martinez L, Ferry JA, Peh SC: Extranodal NK/T-cell lymphoma, nasal type; in Jaffe ES, Harris NL, Stein H, Vardiman JW (eds): World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, IARC Press, 2008, pp 285-288.
6.
Gollub MJ: Imaging of gastrointestinal lymphoma. Radiol Clin North Am 2008;46:287-312.
7.
Chen WL, Tsai WC, Chao TY, Sheu LF, Chou JM, Kao WY, Chen YC, Ho CL: The clinicopathological analysis of 303 cases with malignant lymphoma classified according to the World Health Organization classification system in a single institute of Taiwan. Ann Hematol 2010;89:553-562.
8.
Yang QP, Zhang WY, Yu JB, Zhao S, Xu H, Wang WY, Bi CF, Zuo Z, Wang XQ, Huang J, Dai L, Liu WP: Subtype distribution of lymphomas in Southwest China: analysis of 6,382 cases using WHO classification in a single institution. Diagn Pathol 2011;6:77.
9.
Aoki R, Karube K, Sugita Y, Nomura Y, Shimizu K, Kimura Y, Hashikawa K, Suefuji N, Kikuchi M, Ohshima K: Distribution of malignant lymphoma in Japan: analysis of 2260 cases, 2001-2006. Pathol Int 2008;58:174-182.
10.
Chbani L, Hafid I, Berraho M, Nejjari C, Amarti A: Digestive cancers in Morocco: Fez-Boulemane region. Pan Afr Med J 2012;13:46.
11.
Ghai S, Pattison J, Ghai S, O'Malley ME, Khalili K, Stephens M: Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics 2007;27:1371-1388.
12.
Nakamura S, Matsumoto T, Iida M, Yao T, Tsuneyoshi M: Primary gastrointestinal lymphoma in Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 2003;97:2462-2473.
13.
Gurney KA, Cartwright RA, Gilman EA: Descriptive epidemiology of gastrointestinal non-Hodgkin's lymphoma in a population-based registry. Br J Cancer 1999;79:1929-1934.
14.
Papaxoinis G, Papageorgiou S, Rontogianni D, Kaloutsi V, Fountzilas G, Pavlidis N, Dimopoulos M, Tsatalas C, Xiros N, Economopoulos T: Primary gastrointestinal non-Hodgkin's lymphoma: a clinicopathologic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma 2006;47:2140-2146.
15.
Lewin KJ, Ranchod M, Dorfman RF: Lymphomas of the gastrointestinal tract: a study of 117 cases presenting with gastrointestinal disease. Cancer 1978;42:693-707.
16.
Li M, Zhang S, Gu F, Xiao W, Yao J, Chao K, Chen M, Li J, Zhong B: Clinicopathological characteristics and prognostic factors of primary gastrointestinal lymphoma: a 22-year experience from South China. Int J Clin Exp Pathol 2014;7:2718-2728.
17.
Ding D, Pei W, Chen W, Zuo Y, Ren S: Analysis of clinical characteristics, diagnosis, treatment and prognosis of 46 patients with primary gastrointestinal non-hodgkin lymphoma. Mol Clin Oncol 2014;2:259-264.
18.
Arora N, Manipadam MT, Pulimood A, Ramakrishna BS, Chacko A, Kurian SS, Nair S: Gastrointestinal lymphomas: pattern of distribution and histological subtypes: 10 years experience in a tertiary centre in South India. Indian J Pathol Microbiol 2011;54:712-719.
19.
Warrick J, Luo J, Robirds D, Branson J, Frater JL, Kreisel F, Hassan A, Nguyen TT: Gastrointestinal lymphomas in a North American population: clinicopathologic features from one major Central-Midwestern United States tertiary care medical center. Diagn Pathol 2012;7:76.
20.
Ghimire P, Wu GY, Zhu L: Primary gastrointestinal lymphoma. World J Gastroenterol 2011;17:697-707.
21.
Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, Muller-Hermelink HK, Campo E, Braziel RM, Jaffe ES, Pan Z, Farinha P, Smith LM, Falini B, Banham AH, Rosenwald A, Staudt LM, Connors JM, Armitage JO, Chan WC: Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 2004;103:275-282.
22.
Zhang Z, Shen Y, Shen D, Ni X: Immunophenotype classification and therapeutic outcomes of Chinese primary gastrointestinal diffuse large B-cell lymphoma. BMC Gastroenterol 2012;12:77.
23.
Huang J, Jiang W, Xu R, Huang H, Lv Y, Xia Z, Sun X, Guan Z, Lin T, Li Z: Primary gastric non-Hodgkin's lymphoma in Chinese patients: clinical characteristics and prognostic factors. BMC Cancer 2010;10:358.
24.
Kim SJ, Choi CW, Mun YC, Oh SY, Kang HJ, Lee SI, Won JH, Kim MK, Kwon JH, Kim JS, Kwak JY, Kwon JM, Hwang IG, Kim HJ, Lee JH, Oh S, Park KW, Suh C, Kim WS: Multicenter retrospective analysis of 581 patients with primary intestinal non-Hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL). BMC Cancer 2011;11:321.
25.
Wu X, Li P, Zhao J, Yang X, Wang F, Yang YQ, Fang F, Xu Y, Zhang H, Wang WY, Yi C: A clinical study of 115 patients with extranodal natural killer/T-cell lymphoma, nasal type. Clin Oncol 2008;20:619-625.
26.
Gualco G, Domeny-Duarte P, Chioato L, Barber G, Natkunam Y, Bacchi CE: Clinicopathologic and molecular features of 122 Brazilian cases of nodal and extranodal NK/T-cell lymphoma, nasal type, with EBV subtyping analysis. Am J Surg Pathol 2011;35:1195-1203.
27.
Pongpruttipan T, Sukpanichnant S, Assanasen T, Wannakrairot P, Boonsakan P, Kanoksil W, Kayasut K, Mitarnun W, Khuhapinant A, Bunworasate U, Puavilai T, Bedavanija A, Garcia-Herrera A, Campo E, Cook JR, Choi J, Swerdlow SH: Extranodal NK/T-cell lymphoma, nasal type, includes cases of natural killer cell and αβ, γδ, and αβ/γδ T-cell origin: a comprehensive clinicopathologic and phenotypic study. Am J Surg Pathol 2012;36:481-499.
28.
Li S, Feng X, Li T, Zhang S, Zuo Z, Lin P, Konoplev S, Bueso-Ramos CE, Vega F, Medeiros LJ, Yin CC: Extranodal NK/T-cell lymphoma, nasal type: a report of 73 cases at MD Anderson Cancer Center. Am J Surg Pathol 2013;37:14-23.
29.
Kanemitsu N, Isobe Y, Masuda A, Momose S, Higashi M, Tamaru J, Sugimoto K, Komatsu N: Expression of Epstein-Barr virus-encoded proteins in extranodal NK/T-cell lymphoma, nasal type (ENKL): differences in biologic and clinical behaviors of LMP1-positive and -negative ENKL. Clin Cancer Res 2012;18:2164-2172.
30.
Ying ZT, Zheng W, Wang XP, Xie Y, Tu MF, Lin NJ, Ping LY, Liu WP, Deng LJ, Zhang C, Zhu J, Song YQ: The clinical features, therapeutic responses, and prognosis of the patients with mantle cell lymphoma. Chin J Cancer 2012;31:348-353.
31.
Kim SJ, Jung HA, Chuang SS, Hong H, Guo CC, Cao J, Hong XN, Suzuki R, Kang HJ, Won JH, Chng WJ, Kwong YL, Suh C, Song YQ, Zhu J, Tay K, Lim ST, Suzumiya J, Lin TY, Kim WS: Extranodal natural killer/T-cell lymphoma involving the gastrointestinal tract: analysis of clinical features and outcomes from the Asia Lymphoma Study Group. J Hematol Oncol 2013;6:86.
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