Aplicação institucional do sistema de graduação histológica "gela" para avaliação de biópsias pós-tratamento de pacientes com linfoma do tipo "MALT" gástrico / Institutional application of the "GELA" system for evaluation of follow-up biopsies of gastric MALT lymphoma

O Linfoma da Zona Marginal Extra-Nodal do estômago (Linfoma "MALT" gástrico, do inglês "Mucosa-associated Lymphoid Tissue"), está intimamente associado à infecção pelo Helicobacter pylori (H. pylori). A avaliação de resposta após o tratamento para erradicação do H. pylori requer um seguimento prolongado, com realização de biópsias gástricas de controle. Infiltrados linfoides residuais podem persistir por longos períodos após o tratamento de erradicação, e a avaliação histopatológica quanto à caracterização da presença ou ausência de doença residual pode apresentar dificuldades de interpretação. Em 2003, o Groupe d'Etude des Lymphomas de l'Adulte (GELA) estabeleceu um sistema de graduação histológica (escore "GELA") para avaliação de biópsias pós-tratamento de pacientes com linfoma do tipo "MALT" gástrico. O propósito do nosso estudo foi o de validar o uso deste escore em uma coorte brasileira de 24 pacientes tratados por linfoma MALT gástrico. Observamos uma concordância inter-observador moderada (k = 0,409), com concordância entre todos os avaliadores em apenas 41,6% dos casos. Observou-se que as divergências de avaliação ocorrem nos 3 parâmetros morfológicos utilizados para a definição do escore "GELA" final. Agrupando-se as categorias "Resposta Completa" e "Provável Doença Residual Mínima", foi atingida uma concordância substancial entre os avaliadores (0,743). Conclui-se que o sistema "GELA" possui potencial para uso na prática clínica, uniformizando a linguagem entre patologistas, endoscopistas e clínicos, devendo, entretanto, ter maior penetração e treinamento entre a comunidade de patologistas (AU)

Gastric Marginal Zone Lymphoma (or gastric MALT lymphoma) is an indolent B-cell neoplasm closely associated with Helicobacter pylori (H. pylori) infection. Evaluation of response after treatment for H. pylori eradication requires prolonged follow-up with control biopsies. Residual lymphoid infiltrates may persist for long periods, and histopathological evaluation for the characterization of the presence or absence of residual disease may present interpretation difficulties. In 2003, the Groupe d'Etude des Lymphomas de l'Adulte (GELA) established a histological grading system ("GELA" score) for evaluation of follow-up biopsies of gastric MALT lymphoma. The purpose of our study was to independently validate the use of this histological grading score in a Brazilian cohort of 24 patients treated for gastric MALT lymphoma. We observed moderate interobserver agreement (k = 0.409), with agreement among all evaluators in only 41.6% of cases. We observed that the divergences occur in the 3 morphological parameters used to define the final "GELA" score. When we grouped the categories of "Complete Remission" and "Probable Minimal Residual Disease", we achieved substantial agreement between the observers (k = 0.743). We conclude that the "GELA" system has potential for use in clinical practice, standardizing language among pathologists, endoscopists and clinicians, but should have greater penetration and training among the pathologist community (AU)

Primary non-Hodgkin lymphoma of the prostate: a case report.

This report is of a 68-year-old male patient with a three-year history of severe, progressive, low urinary tract symptoms (LUTS) with a score of 20 points on the International Symptom Scale. The patient received alpha-1-blocker therapy without adequate response. Transurethral resection of the prostate was performed, and the anatomopathological report indicated the presence of a haematolymphoid small-cell neoplasia and glandulostromal prostatic hyperplasia. Posterior immunohistochemistry evaluation reported an extra-nodal marginal zone-B lymphoma non-Hodgkin lymphoma. The patient was followed up for five years by the urology and oncology departments. In the fourth year of follow-up, the patient had B symptoms (fever, night sweats and weight loss). At the same time, laboratory tests showed haemolytic anaemia; then a new bone marrow biopsy was carried out. The histopathological specimen showed six lymphoid aggregates, constituted by a B-cell population with intra-trabecular predominance and reactivity for CD20 and BCL-2. New thoracic and abdominal computed tomographies were performed without any findings suggestive of extra-prostatic spreading. Subsequently, a chemotherapy regimen was started on the patient with the following therapeutic scheme: Rituximab 375 mg/m2 IV per day, cyclophosphamide 750 mg/m2 IV per day, Vincristine 1.4 mg/m2 IV dose per day and Prednisone 40 mg/m2 on days 1-5 (R-CVP scheme) for 21 days, until he completed six cycles. No signs, symptoms or progression have been recorded.

Tejido linfoide y linfomas gástricos / Lymphoid tissue and gastric lymphomas

En este artículo hemos realizado una amplia revisión de los linfomas primarios gástricos, su clasificación y aspectos clínico-patológicos más importantes, haciendo énfasis especial en los linfomas MALT o asociados a las mucosas y su relación con la infección por Helicobacter pylori.

In this review we describe various aspects of the primary gastric lymphomas, the classification, and the most important clinico-pathological aspects, with emphasis in mucosa associated lymphoma (MALT) and the Helicobacter pylori infection.