Primary gastric lymphoma

Table 1 The REAL classification of non-Hodgkin’s Lymphomas

B-cell lymphomas
	Precursor B-cell lymphomas:
		B-lymphoblastic
	Mature B-cell lymphomas:
		B-cell CLL/small lymphocytic
		Follicular
		Marginal-zone-nodal
		Extranodal marginal-zone (MALT)
		Splenic marginal-zone
		Lymphoplasmacytic
		Mantle-cell
		Diffuse large B-cell
		Primary mediastinal large B-cell
		Burkitt’s like
		Burkitt’s
T-cell lymphomas
	Precursor T-cell lymphomas:
		T-lymphoblastic
	Mature T-cell lymphomas:
		Mycosis fungoides/sezary syndrome
		Peripheral T-cell (many subtypes)
		Anaplastic large T/null cell
		Adult T-cell leukemia/lymphoma

Table 2 Histologic classification of gastrointestinal lymphomas

B-cell
	Mucosa-associated lymphoid tissue (MALT)-type
	(extranodal marginal-zone lymphoma):
		Low-grade
		High-grade, with or without a low-grade component
	Immunoproliferative small intestinal disease (IPSID):
		Low-grade
		High-grade, with or without a low-grade component
	Lymphomatous polyposis (mantle-cell lymphoma)
	Burkitt’s and Burkitt’s-like
	Other types of low- or high-grade lymphoma corresponding
	to lymph node equivalents
T-cell
	Enteropathy-associated T-cell lymphoma (EATCL)
	Other types not associated with enteropathy

Table 3 Staging classification according to Musshoff’s criteria

stage	Definition
IE	Lymphoma limited to the stomach
IIE1	Involvement of stomach and contiguous lymph nodes
IIE2	Involvement of stomach and noncontiguous subdiaphragmatic lymph nodes
III	Involvement of stomach and lymph nodes on both sides of diaphragm
IV	Hematogenous spread (stomach and one or more extralymphatic organs or tissues)

The Following subscripts may be added E = extranodal, S = splenic, A = asymptomatic, B = symptomatic.

Table 4 Modified Blackledge staging system for gastrointesti-nal lymphomas

Stage I	Tumor confined to gastrointestinal tract without
	serosal penetration:
	Single
	Multiple,
Stage II	Tumor extending into abdomen from primary site:
	Nodal involvement
	II1 Local (gastric/mesenteric)
	II2 Distant (paraaortic/paracaval)
Stage IIE	Penetration of serosa to involve adjacent ‘structures’:
	Enumerate actual site of involvement, e.g. stage IIE
	(pancreas), stage IIE (large intestine), stage IIE
	(post-abdominal wall)
	Perforation/peritonitis
Stage IV	Disseminated extranodal involvement or a
	gastrointestinal-tract lesion with
	supradiaphragmatic nodal involvement