Hertzer N R, Hoerr S O
Surg Gynecol Obstet. 1976 Jul;143(1):113-24.
Lymphoma of the stomach may exist as a primary lesion or as a manifestation of generalized or systemic lymphoma. The primary lesions constitute approximately 3 per cent of all malignant lesions of the stomach and outnumber all other types of non-epithelial malignant lesions. The cause is not known. Gross characteristics often resemble carcinoma, and like carcinoma, the primary lesion may affect other structures by direct extension, may seed to peritoneal surfaces, may metastasize to lymph nodes near or far, and may be borne by the blood to liver, lung or bone. Diagnosis begins with clinical suspicion by the physician, is supported by the results of roentogenographic and gastroscopic studies, and is finally established by a positive study of biopsy specimens obtained with or without laparotomy. Improvements in both gastroscopic instruments and their use promise to increase greatly the accuracy of preoperative diagnosis. Pseudolymphoma of the stomach, a rare type of inflammatory lesion, may, on occasion, offer a difficult differential diagnosis from that of lymphoma. The clinical approach to the lesion, whether the diagnosis is histologically proved or not, is the same as for suspected carcinoma. A laparotomy is usually necessary to determine the possibility of surgical cure, unless distant spread or systemic involvement can be established by other means, such as a distant lymph node containing the disease or a positive needle biopsy of the liver. When a cure seems possible, resection is favored by most surgeons, even though it entails total gastrectomy or multiple organ resection. Opinion is divided as to whether or not a curative resection should be followed routinely by irradiation, although irradiation is generally favored by palliation of lesions not amenable to resection. Transgastroscopic biopsy and gastroscopic follow-up study may permit radiation to be tested as the only form of treatment of favorable lesions. At the present time, chemotherapy should be reserved for lesions not controlled by operation or irradiation. Stage for stage, the outlook for lymphoma of the stomach is about twice as favorable as that for carcinoma. No generally accepted classification of lymphoma exists as yet. Correlations between prognosis and microscopic characteristics are not close, except for the generally favorable outlook for lymphocytic lymphoma.
胃淋巴瘤可作为原发性病变存在，也可作为全身性或系统性淋巴瘤的一种表现。原发性病变约占胃所有恶性病变的3%，比所有其他类型的非上皮性恶性病变数量更多。病因不明。大体特征常类似于癌，与癌一样，原发性病变可通过直接蔓延累及其他结构，可播散至腹膜表面，可转移至远近不同的淋巴结，还可通过血液转移至肝、肺或骨。诊断始于医生的临床怀疑，得到X线造影和胃镜检查结果的支持，最终通过对经剖腹手术或未行剖腹手术获取的活检标本的阳性检查得以确立。胃镜器械及其使用方法的改进有望大幅提高术前诊断的准确性。胃假性淋巴瘤是一种罕见的炎性病变，有时可能难以与淋巴瘤进行鉴别诊断。无论病变的诊断是否经组织学证实，对其的临床处理方法与疑似癌相同。通常需要进行剖腹手术以确定手术治愈的可能性，除非可通过其他方法确定有远处转移或全身受累，如发现远处有疾病的淋巴结或肝脏穿刺活检阳性。当似乎有可能治愈时，大多数外科医生倾向于进行切除，即使这需要全胃切除或多器官切除。对于治愈性切除后是否应常规进行放疗，意见不一，不过对于无法切除的病变，放疗一般有利于缓解症状。经胃镜活检和胃镜随访研究可能使放疗作为良性病变的唯一治疗方式得到验证。目前，化疗应仅用于手术或放疗无法控制的病变。逐期来看，胃淋巴瘤的预后约为癌的两倍。目前尚无普遍接受的淋巴瘤分类。除淋巴细胞性淋巴瘤总体预后良好外，预后与微观特征之间的相关性并不紧密。
