Clinical characteristics of primary gastrointestinal lymphoma presenting with gastrointestinal bleeding

Primary gastrointestinal lymphoma (PGIL) is the most prevalent form of extranodal lymphoma (EL), with gastrointestinal bleeding (GIB) as a severe complication.

We retrospectively analyzed the clinical data of 59 patients with PGIL who presented with GIB as the initial symptom.

The median age at diagnosis was 65 years, with male predominance (54.2%). Lesions predominantly occurred in the stomach (52.5%), most notably in the gastric body (28.8%); intestinal involvement was more common in the small bowel (18.6%). Clinical manifestations of hemorrhage primarily included a positive fecal occult blood test (FOBT; 81.8%) and hematemesis/melena (40.7%). Owing to the non-specific nature of the symptoms, the initial misdiagnosis proportion reached 11.9%. Endoscopic findings most frequently presented as ulcerative (n = 20, 42.6%) and elevated (n = 17, 36.2%) types. Pathologically, the majority of cases originate from B lymphocytes, with diffuse large B-cell lymphoma (DLBCL) being the most common subtype (54.2%), followed by mucosa-associated lymphoid tissue lymphoma (MALT, 28.8%). Albumin (Alb) and prealbumin (Pre-Alb) levels were significantly lower in the moderate-to-severe anemia group than in the mild anemia group (p < 0.05). Novel inflammatory and nutritional indices-systemic immune-inflammation index (SII) and red blood cell distribution width to albumin ratio (RAR)-were significantly elevated in the moderate-to-severe anemia group (p < 0.05). The treatment modalities mainly consisted of chemotherapy alone (33.9%), surgery (18.6%), and combined surgery with chemotherapy (15.3%).

The clinical manifestations and auxiliary examination results of patients with PGIL were highly heterogeneous, and the misdiagnosis proportion was relatively high. Clinicians should fully understand the clinical characteristics of this disease to formulate individualized treatment plans.