Clinicopathological comparison of the World Health Organization/Wotherspoon score to the Groupe d'Etude des Lymphomes de l'Adult grade for the post-treatment evaluation of gastric mucosa-associated lymphoid tissue lymphoma.
OBJECTIVE
The World Health Organization (WHO) has adopted criteria for the histological differential diagnosis of gastric extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (GML) based on the criteria proposed by Wotherspoon in 1993 (WHO/Wotherspoon score). These histological criteria are commonly used by pathologists for initial diagnoses, but have not been adopted uniformly for the post-treatment evaluation of GML. In 2003, the Groupe d'Etude des Lymphomes de l'Adult (GELA) proposed a new histological grading system (GELA grade) in preference to use of the WHO/Wotherspoon score for post-treatment evaluation. In the present study, we compared the WHO/Wotherspoon and GELA systems to examine which histological criterion is better for post-treatment evaluation.


METHODS
Fourteen cases of GML under long-term follow up were initially diagnosed according to the WHO criteria with detailed immunohistology, and were periodically evaluated with both histological criteria after anti-Helicobacter pylori treatment. They were also evaluated based on histological stromal changes accompanying the disappearance of lymphoma tissue.


RESULTS
The study showed strong similarities between the WHO/Wotherspoon and GELA systems and no clear advantage of either system for post-treatment evaluation. The GELA grade could not be used for the evaluation of changes in the degree of lymphoma infiltration from pre- to post-treatment because the four-item scale is not comparable with the formal six-point WHO/Wotherspoon scale. Stromal changes in the lamina propria, including an empty appearance and fibrosis, were correlated with lymphoma reduction after treatment and appear to be good indicators for post-treatment evaluation.


CONCLUSIONS
We propose the utilization of the WHO/Wotherspoon score accompanied by the assessment of stromal changes for the post-treatment evaluation of GML.
Shiozawa
Eisuke
E
Second Department of Pathology, Showa University School of Medicine, Tokyo, Japan. eshiozawa@aol.com
Norose
Tomoko
T
Kaneko
Kazuhiro
K
Yamochi-Onizuka
Toshiko
T
Takimoto
Masafumi
M
Imawari
Michio
M
Ota
Hidekazu
H
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000187:drug effects; D006416:Hematoxylin; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000382:microbiology / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D013194:Staining and Labeling / Q000379:methods; D017154:Stromal Cells / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014944:World Health Organization
D000900:Anti-Bacterial Agents; D004396:Coloring Agents; D054328:Proton Pump Inhibitors; D004801:Eosine Yellowish-(YS); D006416:Hematoxylin