[Value of upper digestive fibroscopy in the evaluation of initial spread of malignant extradigestive non-Hodgkin's lymphomas. Results in 101 patients].

The aim of this prospective study was to assess the frequency of gastroduodenal involvement during initial staging of extradigestive non Hodgkin's lymphoma. One hundred and one patients (64 men and 37 women; mean age 57.7; range 22-77 years) underwent an upper digestive endoscopy with multiple biopsies before any treatment. The origin of lymphoma was nodal in 76 cases and extranodal in 25 cases. Biopsy specimens were taken from all gross lesions; when the mucosa was considered as normal, biopsy specimens were obtained from the corpus, the antrum, and the duodenum. Endoscopy was normal in 37 patients; nevertheless in 4/37 patients, biopsies revealed lymphoma infiltration. In 64 patients, endoscopy showed macroscopic anomalies: biopsies were negative in 47 patients and showed lymphoma involvement in 17 patients. The involvement site was the corpus of the stomach (11 cases), the antrum (9 cases), and the duodenum (9 cases); lesions were multifocal in 10/21 patients. The association of several types of lesions was noticed in 5 patients. Lesions included volcano-like craters (8 cases), large folds of brain-like appearance (4 cases), tumors greater than 3 cm (3 cases), gastric ulcers (3 cases), erosive gastritis (3 cases), and erythematous duodenitis (2 cases). Overall, 21 of 101 patients (20.8 percent) had positive biopsies, 17 with endoscopic lesions and 4 without. Only 5/21 patients presented upper gastrointestinal symptoms. Staging of the lymphoma changed to Stage IV in 11 patients (4 stage I, 4 stage II and 3 stage III) (10.9 percent) after gastrointestinal involvement was documented. Gastroduodenal involvement is not related to initial site (nodal or extranodal), stage of extension or grade of malignancy of the lymphoma.