[Diagnosis and therapeutic management of gastric lymphomas]. / Diagnóstico y manejo terapéutico de los linfomas gástricos.

PURPOSE: The optimal management of primary gastric non-Hodgkin's lymphoma (PGL) remains controversial. The purpose of this paper is to describe the histopathology, clinical behavior and management of 15 patients with PGL. PATIENTS AND METHODS: All patients were diagnosed of PGL in our Center from January 1985 to September 1995. Resection specimens were reexamined and cases were reclassified according to the concept of MALT-derived lymphoma. Age, sex, symptoms, localization, stage, treatment, complications and response were reported. RESULTS: 9 patients had low-grade B-cell lymphoma of MALT type, 5 had high-grade B-cell lymphoma (one with evidence of low-grade lymphoma of MALT type) and 1 had centroblastic-centrocytic B-cell lymphoma. Seven cases were diagnosed by endoscopy biopsies, 8 through laparatomy specimens. Stage was I in 3 cases, II1 in 5, II2 in 5, III in 0 and IV in 2. 13 patients had undergone primary gastric resection: 10 received additional chemotherapy and 1 radiotherapy. The two cases with stage IV have died: one died after surgery and one relapsed immediately after chemotherapy. After a median follow-up of 40 months, 13 patients are alive: 11 in complete response and 2 in relapse. Minor surgical complications occurred in 12 patients and major complications in 6 patients. CONCLUSIONS: Gastric resection still plays an important role in the management of early-stage PGL. Chemotherapy can be an effective therapeutic procedure in unresected or surgical high-risk patients.