Lymph nodes in gastric B-cell lymphoma: pattern of involvement and early histological changes.
OBJECTIVE
This study aims to analyse the histological pattern of nodal involvement in gastric B-cell lymphoma and to detect early involvement of the lymph nodes.


RESULTS
Histological findings of 37 resected primary gastric lymphomas with 1313 regional lymph nodes were analysed. The primary tumour was classified into four groups: MALT lymphoma, MALT lymphoma with a minor large B-cell lymphoma (<20%), large B-cell lymphoma with MALT lymphoma, and large B-cell lymphoma without MALT lymphoma. Histological patterns of nodal involvement were divided into sinusoidal, subsinusoidal/marginal, follicular, and diffuse patterns. Semi-nested polymerase chain reaction (PCR) analysis for IgH gene rearrangement was performed. Nodal involvement was found in 2/13 (15%) MALT lymphomas, 5/6 (83%) MALT lymphomas with a minor large B-cell lymphoma, 9/12 (75%) large B-cell lymphomas with MALT lymphoma, and 6/6 (100%) large B-cell lymphomas without MALT lymphoma. The MALT lymphoma and MALT lymphoma with a minor large B-cell lymphoma showed a predominantly sinusoidal and subsinusoidal pattern, whereas diffuse pattern predominated in large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. The follicular pattern was least common, being observed in 10.2% of large B-cell lymphomas without MALT lymphoma and large B-cell lymphomas with MALT lymphoma. Sinusoidal obliteration with permeation of small monocytoid cells into subsinusoidal zone is a characteristic finding suggesting early nodal involvement of MALT lymphoma.


CONCLUSIONS
Histological patterns of nodal involvement in gastric B-cell lymphoma vary according to the histological grade. Immunostaining for CD20 with or without PCR analysis for IgH gene rearrangement would be a useful ancillary method to confirm lymphomatous involvement.
Ko
Y H
YH
Department of Diagnostic Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
Han
J J
JJ
Noh
J H
JH
Ree
H J
HJ
D000328:Adult; D000368:Aged; D004268:DNA-Binding Proteins / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D015321:Gene Rearrangement; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000737:chemistry / Q000378:metabolism / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000032:analysis; D051560:Proto-Oncogene Proteins c-bcl-6; D017464:Receptors, Complement 3d / Q000032:analysis; D013274:Stomach Neoplasms / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D014157:Transcription Factors / Q000032:analysis
D004268:DNA-Binding Proteins; D007143:Immunoglobulin Heavy Chains; D011518:Proto-Oncogene Proteins; D051560:Proto-Oncogene Proteins c-bcl-6; D017464:Receptors, Complement 3d; D014157:Transcription Factors