4th Seah Cheng Siang Memorial Lecture. Primary gastrointestinal lymphoma in Hong Kong

Many primary gastrointestinal lymphomas (PGL) are treatable and carry a good prognosis, particularly of localized and of "low grade" malignancy. In general, the stomach is the most commonly involved site followed by the small and then large intestines. The incidence of gastric lymphoma may be on the rise, and the response of lymphoma arising from gastric Mucosa Associated Lymphoid Tissue (MALT) to treatment of the co-existing Helicobacter pylori infection has added a new dimension to the study of PGL. Most PGLs are histologically aggressive and those involving the intestines tend to present late. In a series of 425 adult Chinese patients with PGL seen in Hong Kong between 1975 and 1993, there were 230 males and 195 females with a median age of 53 years. Sites of involvement were the oesophagus in 3, the stomach in 238, small intestines in 131 and large intestines in 53. The majority were of diffuse large cell, small cell, mixed or immunoblastic histology (Working Formulation) and 90% were of B cell origin. At presentation 70.6% had stage II, IV disease (Manchester Classification) and 64.7% had B symptoms. The most common presenting clinical features were abdominal pain, gastrointestinal bleeding, anorexia, vomiting and weight loss. Perforation occurred in 76 patients. Surgery was carried out in 318 (74.8%), radiotherapy in 161 (37.9%) and all patients with advanced diseases received chemotherapy, with or without radiotherapy. The overall 5-year survival was 75% in patients with low grade histology and 70% in those with clinical stage I and II disease.(ABSTRACT TRUNCATED AT 250 WORDS)