Abstract
Aims
The management of primary small bowel and colon lymphoma is controversial. A review of the literature was therefore undertaken to evaluate the evidence for the classification, staging, diagnosis, and treatment of primary small bowel and colon lymphoma and guide management.
Methods
A literature search was performed utilising Embase, Medline, and Pubmed and papers were evaluated on an individual basis.
Results
Consensus opinion favours the WHO classification scheme and the TNM staging systems for primary small bowel and colon lymphoma. CT enteroclysis and barium enterolysis are recommended for the diagnosis of primary small bowel lymphoma and capsule endoscopy and double-balloon enteroscopy maybe useful diagnostic tools. In terms of the diagnosis and staging of primary colonic lymphoma, the evidence is scarce and CT is to be recommended.
The mainstay of treatment for primary GI lymphoma is surgery and/or chemotherapy. For primary small bowel and colonic lymphoma, there was no definitive evidence regarding the benefits of either strategy; however, chemotherapy seemed to give a survival benefit over surgery alone for primary small bowel lymphoma and colonic lymphoma was skewed towards surgery plus chemotherapy due to the large number of patients presenting as an emergency.
Conclusion
Published data regarding the management of primary small bowel and colon lymphoma is very limited. Classification and staging should be standardised to enable accurate evaluation of investigations and treatments and a large RCT undertaken to compare chemotherapy and surgery. Currently, we would recommend that management should involve chemotherapy with surgery reserved for those with clinical indication.
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References
Koch P, del Valle F, Berdel WE, Willich NA, Reers B, Hiddemann W, Grothaus-Pinke B, Reinartz G, Brockmann J, Temmesfeld A, Schmitz R, Rübe C, Probst A, Jaenke G, Bodenstein H, Junker A, Pott C, Schultze J, Heinecke A, Parwaresch R, Tiemann M, German Multicenter Study Group (2001) Primary gastrointestinal non-Hodgkin's lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma—results of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 19(18):3874–3883
Wong MTC, Eu KW (2006) Primary colorectal lymphomas. Color Dis 8:586–591
Yin L, Chen CQ, Peng CH, Chen M, Zhou HJ, Han BS, Li HW (2007) Primary small-bowel non-Hodgkin's lymphoma: a study of clinical features, pathology, management and prognosis. J Int Med Res 35:406–415
Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS (2009) Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 249:63–71
Gustafsson BI, Siddique L, Chan A, Dong M, Drozdov I, Kidd M, Modlin IM (2008) Uncommon cancers of the small intestine, appendix and colon: an analysis of SEER 1973–2004, and current diagnosis and therapy. Int J Oncol 33:1121–1131
Gurney KA, Cartwright RA, Gilman EA (1999) Descriptive epidemiology of gastrointestinal non-Hodkgin's lymphoma in a population-based registry. Br J Cancer 79(11/12):1929–1934
Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336
Koniaris LG, Drugas G, Katzman PJ, Salloum R (2003) Management of gastrointestinal lymphoma. J Am Coll Surg 197(1):127–141
Dickson BC, Serra S, Chetty R (2006) Primary gastrointestinal tract lymphoma: diagnosis and management of common neoplasms. Expert Rev Anticancer Ther 6(11):1609–1628
Gurbuxani S, Anastasi J (2007) What to do when you suspect gastrointestinal lymphoma: a pathologist's perspective. Clin Gastroenterol Hepatol 5(4):417–421
Rohatiner A, d’Amore F, Coiffier B, Crowther D, Gospodarowicz M, Isaacson P, Lister TA, Norton A, Salem P, Shipp M (1994) Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol 5(5):397–400
Ruskoné-Fourmestraux A, Dragosics B, Morgner A, Wotherspoon A, de Jong D (2003) Paris staging system for primary gastrointestinal lymphomas. Gut 52(6):912–913
Nagi B, Verma V, Vaiphei K, Kochhar R, Bhasin D, Singh K (2001) Primary small bowel tumors: a radiologic–pathologic correlation. Abdom Imaging 26:474–480
Minordi LM, Vecchioli A, Guidi L, Mirk P, Fiorentini L, Bonomo L (2006) Multidetector CT enteroclysis versus barium enteroclysis with methylcellulose in patients with suspected small bowel disease. Eur Radiol 16:1527–1536
Boudiaf M, Jaff A, Soyer P, Bouhnik Y, Hamzi L, Rymer R (2004) Small-bowel diseases: prospective evaluation of multi-detector row helical ct enteroclysis in 107 consecutive patients. Radiology 233:338–344
Pilleul F, Penigaud M, Milot L, Saurin JC, Chayvialle JA, Valette PJ (2006) Possible small-bowel neoplasms: contrast-enhanced and water-enhanced multidetector CT enteroclysis. Radiology 241(3):796–801
Hadithi M, Mallant M, Oudejans J, van Waesberghe JHTM, Mulder CJ, Comans EFI (2006) F-FDG PET versus CT for the detection of enteropathy-associated T-Cell lymphoma in refractory celiac disease. J Nucl Med 47:1622–1627
Hoffmann M, Vogelsang H, Kletter K, Zettinig G, Chott A, Raderer M (2003) 18F-Fluoro-deoxy-glucose positron emission tomography (18F-FDG-PET) for assessment of enteropathy-type T cell lymphoma. Gut 52:347–351
Bailey AA, Debinski HS, Appleyard MN, Remedios ML, Hooper JE, Walsh AJ, Selby WS (2006) Diagnosis and outcome of small bowel tumours found by capsule endoscopy; a three-center Australian experience. Am J Gastroenterol 101:2237–2243
Rondonotti E, Pennazio M, Toth E, Menchen P, Riccioni ME, De Palma GD, Scotto F, De Looze D, Pachofsky T, Tacheci I, Havelund T, Couto G, Trigan A, Kofokotsios A, Cannizzaro R, Perez-Quadrado E, de Franchis R (2008) Small-bowel neoplasms in patients undergoing video capsule endoscopy; a multicenter European study. Endoscopy 40:488–495
Spada C, Riccioni ME, Familiari P, Marchese M, Bizzotto A, Costomagna G (2007) Video capsule endoscopy in small-bowel tumours; a single centre experience. Scand J Gastroenterol 43:497–505
Flieger D, Keller R, May A, Ell C, Fischbach W (2005) Capsule endoscopy in gastrointestinal lymphomas. Endoscopy 37(12):1174–1180
Akamatsu T, Kaneko Y, Ota H, Miyabayashi H, Arakura N, Tanaka E (2010) Usefulness of double balloon enteroscopy and video capsule endoscopy for the diagnosis and management of primary follicular lymphoma of the gastrointestinal tract in its early stages. Dig Endosc 22(1):33–38
Mitsui K, Tanaka S, Yamamoto H, Kobayashi T, Ehara A, Yano T, Goto H, Nakase H, Tanaka S, Matsui T, Iida M, Sugano K, Sakamoto C (2009) Role of double-balloon endoscopy in the diagnosis of small-bowel tumors; the first Japanese multicenter study. Gastrointest Endosc 70(3):498–504
Yamagami H, Oshitani N, Hosomi S, Suekane T, Kamata N, Sogawa M, Okazaki H, Watanabe K, Tominaga K, Watanabe T, Fujiwara Y, Arakawa T (2008) Usefulness of double-balloon endoscopy in the diagnosis of malignant small-bowel tumours. Clin Gastroenterol Hepatol 6:1202–1205
Higuchi N, Sumida Y, Nakamura K, Itaba S, Yoshinaga S, Mizutani T, Honda K, Taki K, Murao H, Ogino H, Kanayama K, Akiho H, Goto A, Segawa Y, Yao T, Takayanagi R (2009) Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series. Endoscopy 41:175–178
Almeida N, Fiueiredo P, Lopes S, Gouveia H, Leitão C (2009) Double-balloon enteroscopy and small bowel tumours: a south-European single-centre experience. Dig Dis Sci 54:1520–1524
Gollub MJ (2008) Imaging of gastrointestinal lymphoma. Radiol Clin N Am 46:287–312
Levine MS, Rubesin SE, Pantongrag-Brown L, Buck JL, Herlinger H (1997) Non-Hodgkin's lymphoma of the gastrointestinal tract: radiographic findings. Am J Roentgenol 168:167–172
Wyatt S, Fishman EK, Jones B (1993) Primary lymphoma of the colon and rectum: CT and barium enema correlation. Abdom Imaging 18:376–380
Wyatt SH, Fishman EK, Hruban RH, Siegelman SS (1994) CT of primary colonic lymphoma. Clin Imaging 18:131–141
Byun JH, Ha HK, Kim AY, Kim TK, Ko EY, Lee JK, Yu ES, Myung SJ, Sk Yang, Jung HY, Kim JH (2003) CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract. Radiology 227:59–67
Lee HJ, Han JK, Kim TK, Kim YH, Kim KW, Choi BI (2001) Peripheral T-cell lymphoma of the colon: double-contrast barium enema examination findings in six patients. Radiology 218:751–756
Cheung MC, Housri N, Ogilvie MP, Sola JE, Koniaris LG (2009) Surgery does not adversely affect survival in primary gastrointestinal lymphoma. J Surg Oncol 100:59–64
Sarkhosh K, Bathe OF, Stewart DA, Mack LA (2009) The role of surgical intervention in the management of duodenal lymphoma. J Surg Oncol 99:428–432
Chestovich PJ, Schiller G, Sasu S, Hiatt JR (2007) Duodenal lymphoma: a rare and morbid tumour. Am Surg 73:1057–1062
Ibrahim EM, Ezzat AA, El-Weshi AN, Martin JM, Khafaga YM, Al Rabih A, Ajarim DS, Al-Foudeh MO, Zucca E (2001) Primary intestinal diffuse large B-cell non-Hodgkins lymphoma: clinical features, management, and prognosis of 66 patients. Ann Oncol 12:53–58
Li B, Shi Y, He X, Zou S, Zhou S, Dong M, Yang J, Lui P, Xue L (2008) Primary non-Hodgkin lymphomas in the small and large intestine: clinicopathological characteristics and management of 40 patients. Int J Hematol 87:375–381
Doolabh N, Anthony T, Simmang C, Bieligk S, Lee E, Huber P, Hughes R, Turnage R (2000) Primary colonic lymphoma. J Surg Oncol 74:257–262
Fan CW, Changchien CR, Wang JY, Chen JS, Hsu KC, Tang R, Chiang JM (2000) Primary colorectal lymphoma. Dis Colon Rectum 43:1277–1282
Avilés A, Neri N, Huerta-Guzmán J (2002) Large bowel lymphoma: an analysis of prognostic factors and therapy in 53 patients. J Surg Oncol 80:111–115
Kim YH, Lee JH, Yang SK, Kim TI, Kim JS, Kim HJ, Kim JI, Kim SW, Kim JO, Jung IK, Jung SA, Jung MK, Kim HS, Myung SJ, Kim WH, Rhee JC, Choi KY, Song IS, Hyun JH, Min YI (2005) Primary colon lymphoma in Korea: A KASID (Korean Association for the Study of Intestinal Diseases) study. Dig Dis Sci 50(12):2243–2247
Gonzalez QH, Heslin MJ, Da Vila-Cervantes A, Alvarez-Tostado J, Monteros AE, Shore G, Vickers SM (2008) Primary colonic lymphoma. Am Surg 74:214–216
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Beaton, C., Davies, M. & Beynon, J. The management of primary small bowel and colon lymphoma—a review. Int J Colorectal Dis 27, 555–563 (2012). https://doi.org/10.1007/s00384-011-1309-2
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DOI: https://doi.org/10.1007/s00384-011-1309-2