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Эндоскопические критерии ранней дифференциальной диагностики гастритоподобного варианта первичных неходжкинских лимфом и рака желудка
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
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Lozovaia VV, Malikhova OA, Tumanyan AO, Gusarova OA. Endoscopic criteria for early differential diagnosis of gastritis-like form of primary non-Hodgkin's lymphomas and gastric cancer: A prospective study. Journal of Modern Oncology. 2023;25(3):357–364. DOI: 10.26442/18151434.2023.3.202363
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Материалы и методы. В проспективном исследовании, проходившем на базе эндоскопического отделения ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» в период с 2019 по июнь 2023 г., проанализированы данные комплексной эндоскопической диагностики, эндосонографического и морфологического исследований 106 пациентов с гастритоподобными вариантами первичных НХЛ желудка, АК и ПКР желудка. Комплексное эндоскопическое исследование включало осмотр в режимах белого света, увеличения, узкоспектральной визуализации (NBI, BLI, LCI), сочетанного осмотра в режимах узкоспектральной визуализации и увеличения.
Результаты. По результатам морфологического исследования все пациенты были разделены на три группы: MALT-лимфома желудка – 38 (35,8%) пациентов, АК желудка – 33 (31,1%) пациента и ПКР желудка – 35 (33,1%) пациентов. При MALT-лимфоме желудка опухоль чаще всего локализовалась в антральном отделе желудка (52,6%), при АК и ПКР – в теле желудка (45,5 и 60% соответственно). Наиболее крупные размеры опухоли наблюдались при ПКР желудка. В структуре опухоли при MALT-лимфоме желудка в 100% наблюдений определялись множественные точечные участки микродепрессий и мультицентричный характер поражения. При АК – участок депрессии в центральной части опухоли (45,5%), при ПКР – протяженные участки микродепрессий (51,4%) и мультицентричный характер поражения. При MALT-лимфоме желудка ямочный рисунок в 63,2% случаев по типу «воздушного шара», сосудистый в 84,2% случаев – древовидного типа. При АК сосудистый рисунок – петлевого типа (42,4%), при ПКР – штопорообразного типа (74,3%). Демаркационная линия наблюдалась только при АК (100%). При эндосонографическом исследовании при MALT-лимфоме опухоль исходила из глубоких слоев слизистого слоя (100%), изменения регионарных лимфатических узлов (ЛУ) отсутствовали, при АК – из слизистой оболочки (100%), ЛУ не изменены, при ПКР – подслизистый характер распространения опухоли (100%), изменения в ЛУ (40%).
Заключение. Для улучшения качества эндоскопического исследования злокачественных гастритоподобных поражений желудка, определения глубины инвазии и распространения опухолевого процесса, оценки состояния регионарного лимфоколлектора необходимо проведение комплексного эндоскопического исследования с применением всех уточняющих методов эндоскопической диагностики.
Ключевые слова: первичные неходжкинские лимфомы желудка, аденокарцинома желудка, перстневидно-клеточный рак желудка, ранний рак, MALT-лимфома, гастритоподобная форма первичных неходжкинских лимфом желудка, эндоскопическая диагностика
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Aim. To reveal and study basic endoscopic differential-significant criteria characterizing gastric-like form of primary non-Hodgkin's lymphoma (NHL) from adenocarcinoma and signet-ring cell carcinoma (SRCC) of the stomach.
Materials and methods. In the prospective study, based of Blokhin National Medical Research Center of Oncology in the period from 2019 to June 2023, 106 patients with gastritic-like forms of primary NHL, adenocarcinoma and SRCC of the stomach were analyzed. Complex endoscopic study included examination in the modes of white light, magnification, narrow-band imaging (NBI, BLI, LCI) was done.
Results. All patients were divided into three groups: MALT gastric lymphoma (38 patients, 35.8%), gastric adenocarcinoma (33 patients, 31.1%), and SRCC (35 patients, 33.1%). At MALT-lymphoma the tumor was localized in the antrum of the stomach (52.6%),adenocarcinoma and SRCC – in the body (45.5 and 60%). In the tumor structure in MALT-lymphoma of the stomach in 100% of cases multiple point areas of microdepressions and multicenter character of the lesion were determined. At adenocarcinoma – depressed area in the central part of tumor (45.5%), at SRCC – extended areas of microdepressions (51.4%) and multicentric character of lesions. At MALT-lymphoma the pit pattern in 63.2% is of "balloon" type, vascular – of tree-like type (84.2%). In adenocarcinoma the vascular pattern was of the loop-type (42.4%), in SRCC – of the corkscrew-type (74.3%). Demarcation line was observed only in adenocarcinoma (100%). At endosonographic study at MALT-lymphoma the tumor was coming from deep layers of mucous coat (100%), changes of regional lymph nodes (LN) were absent, at adenocarcinoma – from mucous membrane (100%), LN were not changed, at SRCC – submucous spread of tumor (100%), changes in LN (40%).
Conclusion. Complex endoscopic examination is necessary to improve the quality of endoscopic examination of malignant gastric-like tumors, to determine the depth of invasion and spread of the tumor process, to assess the regional lymph drainage.
Keywords: primary non-Hodgkin's lymphoma of the stomach, adenocarcinoma of the stomach, signet ring cell carcinoma of the stomach, early cancer, MALT-lymphoma, gastritis-like form of primary non-Hodgkin's lymphoma of the stomach, endoscopic diagnostics
2. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17(6):697-707. DOI:10.3748/wjg.v17.i6.697
3. Vlăduţ C, Ciocîrlan M, Costache, et al. Is mucosa‑associated lymphoid tissue lymphoma an infectious disease? Role of Helicobacter pylori and eradication antibiotic therapy (Review). Exp Ther Med. 2020;20(4):3546-53. DOI:10.3892/etm.2020.9031
4. Feldman M, Lawrence JB. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th edition. Philadelphia: Elsevier Saunders, 2015; 473-7.
5. Sugita S, Iijima T, Furuya S, et al. Gastric T-cell lymphoma with cytotoxic phenotype. Pathol Int. 2007;57(2):108-14. DOI:10.1111/j.1440-1827.2006.02065.x
6. Bhandari A, Crowe SE. Helicobacter pylori in Gastric Malignancies. Curr Gastroenterol Rep. 2012;14(6):489-96. DOI:10.1007/s11894-012-0296-y
7. Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther. 2011;34(9):1047-62. DOI:10.1111/j.1365-2036.2011.04839.x
8. Hussell T, Isaacson PG, Crabtree JE, Spencer J. Helicobacter pylori-specific tumour-infiltrating T cells provide contact dependent help for the growth of malignant B cells in low-grade gastric lymphoma of mucosa-associated lymphoid tissue. J Pathol. 1996;178(2):122-7. DOI:10.1002/(SICI)1096‑9896(199602)178:2<122::AID-PATH486>3.0.CO;2-D
9. Ruskoné-Fourmestraux A, Fischbach W, Aleman BM, et al. EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut. 2010;60(6):747-58. DOI:10.1136/gut.2010.224949
10. Ruskoné-Fourmestraux A, Dragosics B, Morgner A, et al. Paris staging system for primary gastrointestinal lymphomas. Gut. 2003;52(6):912-3. DOI:10.1136/gut.52.6.912
11. Малихова О.А. Современная стратегия комплексной эндоскопической диагностики и мониторинг неходжкинских лимфом желудка. Дис. … д-ра мед. наук. М., 2010 [Malikhova OA. Sovremennaia strategiia kompleksnoi endoskopicheskoi diagnostiki i monitoring nekhodzhkinskikh limfom zheludka. Dis. … d-ra med. nauk. Moscow, 2010 (in Russian)].
12. Kelessis NG, Vassilopoulos PP, Tsamakidis KG, et al. Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue. Surg Endosc. 2003;17(3):469-74. DOI:10.1007/s00464-002-8544-0
13. Nonaka K, Ishikawa K, Arai S, et al. A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis. World J Gastrointest Endosc. 2012;4(4):151‑6. DOI:10.4253/wjge.v4.i4.151
14. Deng P, Min M, Ma CY, Liu Y. Linked color imaging technology for diagnosis of gastric mucosa-associated lymphoid tissue lymphoma. Chin Med J (Engl). 2017;130(22):2759-60. DOI:10.4103/0366-6999.214137
15. Mehra M, Agarwal B. Endoscopic diagnosis and staging of mucosa-associated lymphoid tissue lymphoma. Curr Opin Gastroenterol. 2008;24(5):623-6. DOI:10.1097/MOG.0b013e32830bf80f
16. Iftikhar J, Siddique MZ, Saqib M, et al. Gastric lymphoma: severe gastric outlet obstruction warranting stent placement. J Coll Physicians Surg Pak. 2022;32(8):S150-2. DOI:10.29271/jcpsp.2022.Supp2.S150
17. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82(2):228-31. PMID:7054024
18. Chiarello MM, Fico V, Pepe G, et al. Early gastric cancer: A challenge in Western countries. World J Gastroenterol. 2022;28(7):693-703. DOI:10.3748/wjg.v28.i7.693
19. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. DOI:10.3322/caac.21660
20. Murakami T, Shoji T, Suzuki K, et al. Simultaneous occurrence of early gastric carcinoma and mucosa-associated lymphoid tissue lymphoma of the omentum. Case Rep Gastroenterol. 2014;8(1):101-6. DOI:10.1159/000362158
21. Suwa T, Uotani T, Inui W, et al. A case of signet ring cell carcinoma and mucosa-associated lymphoid tissue lymphoma of the stomach diagnosed simultaneously via magnifying endoscopy with narrow-band imaging. Clin J Gastroenterol. 2021;14(2):453-9. DOI:10.1007/s12328-020-01325-y
22. Peng T, Deng L, Wang Y, et al. Establishing an endoscopic diagnostic process system (M-system) for gastric MALT lymphoma of superficial-spreading type. Jpn J Clin Oncol. 2021;51(4):560-8. DOI:10.1093/jjco/hyaa242
23. Kawamura M, Abe S, Oikawa K, et al. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J Gastroenterol Hepatol. 2011;26(3):477-83. DOI:10.1111/j.1440-1746.2010.06527.x
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1. Papaxoinis G, Papageorgiou S, Rontogianni D, et al. Primary gastrointestinal non-Hodgkin's lymphoma: A clinicopathologic study of 128 cases in Greece. A Hellenic Cooperative Oncology Group study (HeCOG). Leuk Lymphoma. 2006;47:2140-6. DOI:10.1080/10428190600709226
2. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol. 2011;17(6):697-707. DOI:10.3748/wjg.v17.i6.697
3. Vlăduţ C, Ciocîrlan M, Costache, et al. Is mucosa‑associated lymphoid tissue lymphoma an infectious disease? Role of Helicobacter pylori and eradication antibiotic therapy (Review). Exp Ther Med. 2020;20(4):3546-53. DOI:10.3892/etm.2020.9031
4. Feldman M, Lawrence JB. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th edition. Philadelphia: Elsevier Saunders, 2015; 473-7.
5. Sugita S, Iijima T, Furuya S, et al. Gastric T-cell lymphoma with cytotoxic phenotype. Pathol Int. 2007;57(2):108-14. DOI:10.1111/j.1440-1827.2006.02065.x
6. Bhandari A, Crowe SE. Helicobacter pylori in Gastric Malignancies. Curr Gastroenterol Rep. 2012;14(6):489-96. DOI:10.1007/s11894-012-0296-y
7. Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther. 2011;34(9):1047-62. DOI:10.1111/j.1365-2036.2011.04839.x
8. Hussell T, Isaacson PG, Crabtree JE, Spencer J. Helicobacter pylori-specific tumour-infiltrating T cells provide contact dependent help for the growth of malignant B cells in low-grade gastric lymphoma of mucosa-associated lymphoid tissue. J Pathol. 1996;178(2):122-7. DOI:10.1002/(SICI)1096‑9896(199602)178:2<122::AID-PATH486>3.0.CO;2-D
9. Ruskoné-Fourmestraux A, Fischbach W, Aleman BM, et al. EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT. Gut. 2010;60(6):747-58. DOI:10.1136/gut.2010.224949
10. Ruskoné-Fourmestraux A, Dragosics B, Morgner A, et al. Paris staging system for primary gastrointestinal lymphomas. Gut. 2003;52(6):912-3. DOI:10.1136/gut.52.6.912
11. Malikhova OA. Sovremennaia strategiia kompleksnoi endoskopicheskoi diagnostiki i monitoring nekhodzhkinskikh limfom zheludka. Dis. … d-ra med. nauk. Moscow, 2010 (in Russian).
12. Kelessis NG, Vassilopoulos PP, Tsamakidis KG, et al. Is gastroscopy still a valid diagnostic tool in detecting gastric MALT lymphomas? A dilemma beyond the eye. Mucosa-associated lymphoid tissue. Surg Endosc. 2003;17(3):469-74. DOI:10.1007/s00464-002-8544-0
13. Nonaka K, Ishikawa K, Arai S, et al. A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis. World J Gastrointest Endosc. 2012;4(4):151‑6. DOI:10.4253/wjge.v4.i4.151
14. Deng P, Min M, Ma CY, Liu Y. Linked color imaging technology for diagnosis of gastric mucosa-associated lymphoid tissue lymphoma. Chin Med J (Engl). 2017;130(22):2759-60. DOI:10.4103/0366-6999.214137
15. Mehra M, Agarwal B. Endoscopic diagnosis and staging of mucosa-associated lymphoid tissue lymphoma. Curr Opin Gastroenterol. 2008;24(5):623-6. DOI:10.1097/MOG.0b013e32830bf80f
16. Iftikhar J, Siddique MZ, Saqib M, et al. Gastric lymphoma: severe gastric outlet obstruction warranting stent placement. J Coll Physicians Surg Pak. 2022;32(8):S150-2. DOI:10.29271/jcpsp.2022.Supp2.S150
17. Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82(2):228-31. PMID:7054024
18. Chiarello MM, Fico V, Pepe G, et al. Early gastric cancer: A challenge in Western countries. World J Gastroenterol. 2022;28(7):693-703. DOI:10.3748/wjg.v28.i7.693
19. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. DOI:10.3322/caac.21660
20. Murakami T, Shoji T, Suzuki K, et al. Simultaneous occurrence of early gastric carcinoma and mucosa-associated lymphoid tissue lymphoma of the omentum. Case Rep Gastroenterol. 2014;8(1):101-6. DOI:10.1159/000362158
21. Suwa T, Uotani T, Inui W, et al. A case of signet ring cell carcinoma and mucosa-associated lymphoid tissue lymphoma of the stomach diagnosed simultaneously via magnifying endoscopy with narrow-band imaging. Clin J Gastroenterol. 2021;14(2):453-9. DOI:10.1007/s12328-020-01325-y
22. Peng T, Deng L, Wang Y, et al. Establishing an endoscopic diagnostic process system (M-system) for gastric MALT lymphoma of superficial-spreading type. Jpn J Clin Oncol. 2021;51(4):560-8. DOI:10.1093/jjco/hyaa242
23. Kawamura M, Abe S, Oikawa K, et al. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J Gastroenterol Hepatol. 2011;26(3):477-83. DOI:10.1111/j.1440-1746.2010.06527.x
1ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*lera.lozovaya@bk.ru
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Valeria V. Lozovaia*1, Olga A. Malikhova1,2, Armen O. Tumanyan1, Olga A. Gusarova1
1Blokhin National Medical Research Center of Oncology, Moscow, Russia;
2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*lera.lozovaya@bk.ru