Evidence of a malignant cycle in early gastric lymphoma

In order to investigate whether, by analogy with early gastric carcinomas, evidence of a malignant cycle could be found in early gastric non-Hodgkin's lymphomas (EGL), a study of 135 surgical specimens (46 gastrectomies, 80 aboral resections, nine local excisions) was performed. A malignant cycle was considered to have been shown when regenerative changes in the mucosa and fibrosis of the adjacent submucosa were detected. The depth of tumour infiltration was characterized using the UICC classification for gastric carcinomas. An EGL was found in 51.1% of cases (n = 69). The correlation between depth of infiltration and the histological classification of tumours proved statistically significant (p < 0.0001). Evidence of a malignant cycle was demonstrated in 72.5% of EGLs as compared with 27.3% in gastric lymphomas showing deeper infiltration (AL). The same held true for the histological classification of lymphomas. Findings consistent with a malignant cycle were found in 72.7% of low-grade compared with 37.7% of high-grade lymphomas. The difference in distribution proved to be statistically significant in both cases (p < 0.001). Most cases were localized in the antral region (53.6% of EGLs, 40.9% of ALs) and the lower third of the stomach (44.9% of EGLs and 33.3% of ALs). Detecting evidence of a malignant cycle, especially in EGL, has important diagnostic implications, requiring a careful search for minute lymphoma-associated irregularities in the neighbourhood of healed lesions, with the aim of determining the proper locations for a diagnostic biopsy.