Primary gastrointestinal non-Hodgkin's lymphomas. Clinical presentation and results of treatment

During the period of 1978-1988, 36 patients were treated for primary gastrointestinal non-Hodgkin's lymphoma (PGIL) at the Second Department of Surgery, Helsinki University Central Hospital. There were 16 gastric, 15 small intestinal, four large bowel lymphomas, and one case of diffuse multiple lymphomatous polyposis (MLP) of the gastrointestinal tract. Most frequently the disease occurred in middle-aged patients equally in both sexes. Symptoms were non-specific. Abdominal pain was the most common symptom occurring in 30 patients (83%), followed by nausea in 17 patients (47%). Fever occurred in seven patients (20%). Bleeding occurred in ten patients (28%), obstruction in five (14%), and perforation in three patients (8%). An abdominal mass was felt in ten patients (28%). Radiological findings were mostly non-specific but suggested malignant tumour. A definitive diagnosis was difficult to confirm by endoscopic examination. Thirty-five patients underwent surgery, curative in 19 (12 gastric, five small intestine lymphomas (SIL), two large intestine lymphomas (LIL)), and palliative in 12 patients (two gastric, eight SIL, one LIL, and one case of MLP). One patient (gastric) underwent exploration and three had other procedures (two SIL, one LIL). 89% of the patients who had a curative resection survived five years, compared with 28% of those who had palliative resection. The stage of the disease was a very important prognostic factor: the five-year survival was 92% for patients with Stage I disease, while none of the patients with Stage IV disease survived five years. Also, adjuvant therapy was a statistically significant variable affecting survival, and the site of the tumour. Patients with gastric lymphoma had better survival than those with small and large intestinal lymphoma.