Intestinal lymphoma and sprue: a systematic approach

Intestinal lymphoma is frequently associated with sprue-like bowel patterns. A standardized approach to the problem is suggested.Intestinal lymphoma has been subdivided into four groups, depending on the extent of involvement of the anatomical region. Only cases with specific lesions are accepted as primary lymphoma. The villous pattern in 179 cases at necropsy with suitably preserved mucosa was determined to form a normal baseline for comparison with the uninvolved portions of the lymphomatous small bowel. Only 15% of all small bowel of this random material of children more than 1 year old and adults showed a flattened mucosa. The non-lymphomatous mucosa of 20 cases with definitely primary intestinal reticulum or lymphosarcoma showed severe sprue-like atrophy in 18 (90%). Two cases of intestinal Hodgkin's disease and four cases of gastric lymphoma were associated with regular mucosal patterns. It is concluded that sprue-like villous atrophy of the small bowel is definitely a triggering factor for the development of primary intestinal reticulum cell or lymphosarcoma. A hypothesis for the possible aetiological relationship of these two conditions is discussed.