Histologic and Immunohistologic Findings and Prognosis of 40 Cases of Gastric Large B-Cell Lymphoma

It has been considered that gastric large B cell lymphoma mainly consists of mucosa-associated lymphoid tissue lymphoma (MALToma) with large cell transformation. However, debate continues about the cell lineage. We analyzed 61 operated cases of gastric B cell lymphoma, mainly focusing on 40 cases of diffuse large cell lymphoma (DLCL). Immunohistologically, two cases were classified as CD10-positive follicular lymphoma, 19 cases were low-grade MALToma, 11 CD10-negative DLCL with a component of low-grade MALToma (high-grade MALToma), 12 CD10-positive DLCL, and 17 CD10-negative DLCL without MALToma (pure DLCL). Lymphoepithelial lesion (LEL) was found in all -cases of high-grade MALToma, and in eight of these its invasion was confined to the mucosa and submucosa. Expression of Bcl-6 was detected in two cases of high-grade MALToma. Only two cases of CD10-positive DLCL had large cell LEL, and seven cases showed tumor invasion beyond the submucosa. All 12 cases were positive for Bcl-6, and a delicate meshwork of CD35 (Ber-MAC-DRC)-positive follicular dendritic cells was detected in eight cases. Pure DLCL of all 17 cases reached the proper muscle layer or more, and expression of Bcl-6 was detected in 10 cases. For patients with pure DLCL, overall survival was significantly (p <0.05) worse than those of high-grade MALToma and CD10-positive DLCL by Kaplan-Meier and log-rank methods. Clinical staging and Bcl-6 expression were also good prognostic factors in patients with DLCL. Three groups of gastric DLCL each had unique histologic findings, immunohistologic characteristics, and prognosis.

[1]  R. Gascoyne,et al.  Bcl-6 and Bcl-2 protein expression in diffuse large B-cell lymphoma and follicular lymphoma: correlation with 3q27 and 18q21 chromosomal abnormalities. , 1999, Human pathology.

[2]  P. Marynen,et al.  The apoptosis inhibitor gene API2 and a novel 18q gene, MLT, are recurrently rearranged in the t(11;18)(q21;q21) associated with mucosa-associated lymphoid tissue lymphomas. , 1999, Blood.

[3]  P. Mclaughlin,et al.  Follicular large cell lymphoma , 1999 .

[4]  W. Finn,et al.  CD10 antigen expression correlates with the t(14;18)(q32;q21) major breakpoint region in diffuse large B-cell lymphoma. , 1999, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[5]  H. Müller-Hermelink,et al.  Immunoglobulin VH genes of high-grade mucosa-associated lymphoid tissue lymphomas show a high load of somatic mutations and evidence of antigen-dependent affinity maturation. , 1998, Laboratory investigation; a journal of technical methods and pathology.

[6]  De Wolf‐Peeters,et al.  Controversies in MALT lymphoma classification, low and high grade , 1998, Histopathology.

[7]  T. Yoshino,et al.  bcl-6 protein is identified in high-grade but not low-grade mucosa-associated lymphoid tissue lymphomas of the stomach. , 1998, Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc.

[8]  S. Iida,et al.  Heterologous Promoters Fused to BCL6 by Chromosomal Translocations Affecting Band 3q27 Cause Its Deregulated Expression During B-Cell Differentiation , 1998 .

[9]  A. Rosenwald,et al.  The t(11;18)(q21;q21) chromosome translocation is a frequent and specific aberration in low-grade but not high-grade malignant non-Hodgkin's lymphomas of the mucosa-associated lymphoid tissue (MALT-) type. , 1997, Cancer research.

[10]  S. Ishiguro,et al.  Reassessment of gastric lymphoma in light of the concept of mucosa‐associated lymphoid tissue lymphoma , 1997, Cancer.

[11]  S. Swerdlow,et al.  Ongoing Ig gene hypermutation in salivary gland mucosa-associated lymphoid tissue-type lymphomas. , 1997, Blood.

[12]  P. Gaulard,et al.  Follicular large-cell lymphoma treated with intensive chemotherapy: an analysis of 89 cases included in the LNH87 trial and comparison with the outcome of diffuse large B-cell lymphoma. Groupe d'Etude des Lymphomes de l'Adulte. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  M. Du,et al.  Ongoing mutation in MALT lymphoma immunoglobulin gene suggests that antigen stimulation plays a role in the clonal expansion. , 1996, Leukemia.

[14]  M. Kojima,et al.  Clinicopathologic study of primary gastric lymphoma of B cell phenotype with special reference to low‐grade B cell lymphoma of mucosa‐associated lymphoid tissue among the Japanese , 1995, Pathology international.

[15]  T. Yoshino,et al.  Expression of Bcl-2 protein and Fas antigen in non-Hodgkin's lymphomas. , 1994, The American journal of pathology.

[16]  M. Ladanyi,et al.  Rearrangement of the bcl-6 gene as a prognostic marker in diffuse large-cell lymphoma. , 1994, The New England journal of medicine.

[17]  B. Coiffier,et al.  Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. , 1994, Annals of oncology : official journal of the European Society for Medical Oncology.

[18]  A. Ho,et al.  Bcl-2 gene rearrangements in primary B-cell lymphoma of the gastrointestinal tract reveal follicular lymphoma as a subtype. , 1993, Leukemia.

[19]  H. Radzun,et al.  Monoclonal antibody Ki-M4 specifically recognizes human dendritic reticulum cells (follicular dendritic cells) and their possible precursor in blood , 1983 .

[20]  P. Watson,et al.  NCL-CD10-270: a new monoclonal antibody recognizing CD10 in paraffin-embedded tissue. , 1999, The American journal of pathology.

[21]  A. Eisbruch,et al.  Classification of primary gastric lymphomas according to histologic features. , 1998, The American journal of surgical pathology.

[22]  S. Iida,et al.  Heterologous promoters fused to BCL6 by chromosomal translocations affecting band 3q27 cause its deregulated expression during B-cell differentiation. , 1998, Blood.

[23]  P. Isaacson,et al.  Recent developments in our understanding of gastric lymphomas. , 1996, The American journal of surgical pathology.

[24]  J. Skinner.  GASTROINTESTINAL LYMPHOMA , 1985, Pathology.

[25]  P. Mclaughlin,et al.  Follicular large cell lymphoma: an aggressive lymphoma that often presents with favorable prognostic features. , 1999, Blood.