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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 10, 2015; 7(10): 928-949
Published online Aug 10, 2015. doi: 10.4253/wjge.v7.i10.928
Rare gastrointestinal lymphomas: The endoscopic investigation
Calogero Vetro, Giacomo Bonanno, Giorgio Giulietti, Alessandra Romano, Concetta Conticello, Annalisa Chiarenza, Paolo Spina, Francesco Coppolino, Rosario Cunsolo, Francesco Di Raimondo
Calogero Vetro, Alessandra Romano, Concetta Conticello, Annalisa Chiarenza, Paolo Spina, Francesco Di Raimondo, Division of Hematology, A.O. “Policlinico-Vittorio Emanuele”, University of Catania, 95124 Catania, Italy
Giacomo Bonanno, Division of Gastroenterology, A.O. “Policlinico-Vittorio Emanuele”, 95129 Catania, Italy
Giorgio Giulietti, Department of Diagnostic and Interventional Radiology, A.O. “Policlinico-Vittorio Emanuele”, 95124 Catania, Italy
Francesco Coppolino, Department of Radiology, University of Palermo, 90141 Palermo, Italy
Rosario Cunsolo, Health Direction, A.O. “Policlinico-Vittorio Emanuele”, 95129 Catania, Italy
Author contributions: Vetro C is the primary author of the study and was involved in literature search and data collection and wrote the paper; Bonanno G and Giulietti G provided the figures, were content experts and involved in editing the manuscript; Vetro C, Romano A, Conticello C, Chiarenza A, Spina P, Coppolino F and Cunsolo R were content experts and involved in editing the manuscript; Vetro C and Di Raimondo F analyzed the data and were involved in editing the manuscript; Di Raimondo F was the principal investigator, content expert and involved in editing the manuscript.
Conflict-of-interest statement: No conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Calogero Vetro, MD, Division of Hematology, A.O. "Policlinico-Vittorio Emanuele", University of Catania, Via Citelli 6, 95124 Catania, Italy. gerovetro@gmail.com
Telephone: +39-95-7435916 Fax: +39-95-365174
Received: March 12, 2015
Peer-review started: March 13, 2015
First decision: April 23, 2015
Revised: June 1, 2015
Accepted: July 8, 2015
Article in press: July 9, 2015
Published online: August 10, 2015
Processing time: 158 Days and 15.9 Hours
Abstract

Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease.

Keywords: Endoscopy; Lymphoma; Endosonography; Stomach; Intestine

Core tip: The gastrointestinal tract can be the site of rare lymphomas as a primary or secondary localization. Their endoscopic behavior has been scantily evaluated but is emerging as a useful tool with prognostic and therapeutic implications. T-cell lymphomas present mainly with ulcerative lesions, while B-cell lymphomas (follicular or mantle cell lymphomas) present as a duodenal mass or multiple polyposis. Plasma cell-related disorders localize to the gastrointestinal tract, either as a neoplastic mass or as an amyloid deposition. Immunodeficits (primary or secondary) can lead to gastrointestinal localization of rare and seldom fatal high-grade lymphomas. More rarely, Hodgkin’s lymphoma localizes to the gastrointestinal tract with an uncertain impact on prognosis.