Diffuse histiocytic lymphoma presenting with gastrointestinal tract lesions. The Stanford experience

The medical records of all patients with diffuse histiocytic lymphoma (DHL) presenting for treatment at the Stanford University Medical Center between 1970-1978 were reviewed. From this group of 284 patients, 48 were identified with gastrointestinal tract lesions at initial evaluation. Abdominal pain was the most common presenting symptom. Anorexia, weight loss, malaise, and weakness were also common complaints. Twenty percent of these patients noted abdominal masses and 15% experienced gastrointestinal bleeding. Gastric involvement was found in 56% of patients, small intestine in 25%, large intestine in 10%, and pancreas 8%. Following treatment, 83% of Stage IE patients, 43% of Stage IIE patients, and 27% of patients with Stage III and IV DHL achieved durable complete remissions. Considering all stages, a 54% complete remission rate was observed. Of the 26 patients achieving a complete remission, seven have relapsed and the remaining continue free of disease from 6+ to 82+ months. The median survival for patients obtaining a CR was greater than 36 months. Gastrointestinal bleeding or perforation probably as a consequence of therapy was noted 25% of patients. The implications of these findings for improved therapeutic programs and investigations are discussed.