title: Primary low-grade and high-grade gastric MALT-lymphoma presentation.
abstract: OBJECTIVE
  To assess the clinical and endoscopic presentation of primary gastric lymphoma.
  
  
  BACKGROUND
  Remission rate and long-term survival in patients with gastric lymphoma mainly depend on disease stage at diagnosis. Series reporting clinical and endoscopic presentation of gastric lymphoma are generally small and heterogeneous.
  
  
  METHODS
  Systematic review with pooled-data analysis assessing clinical and endoscopic presentation of primary gastric lymphoma.
  
  
  RESULTS
  Data regarding 2000 patients were collected. Overall, males were slightly more prevalent, alarm symptoms were absent in near half of the patients, lymphoma was diagnosed in a stage >I in one-third of the patients, and Helicobacter pylori infection was present in 88.8% of considered patients. At endoscopy, the ulcerative type was the most frequent presentation, although low-grade lymphoma was diagnosed on normal/hyperemic gastric mucosa in 9% of cases. Patients with high-grade lymphoma presented alarm symptoms (anemia and/or melena and/or hemorrhage, persistent vomiting, weight loss), an exophytic or ulcerative lesion, a stage III-IV, and a H. pylori negative status more frequently than low-grade lymphoma cases.
  
  
  CONCLUSIONS
  Our pooled-data analysis showed that gastric lymphoma is still disappointingly diagnosed in an advanced stage in a large number of patients. This is probably due to presence of nonspecific symptoms at initial clinical presentation and/or a normal appearing mucosa at endoscopic observation in the early stages.
authors.affiliation: Gastroenterology and Digestive Endoscopy, Haematology,Nuovo Regina Margherita Hospital, La Sapienza University, Rome, Italy. zullo66@yahoo.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Andriani
authors.forename: Francesca
authors.initials: F
authors.lastname: Cristofari
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cardinale
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Spinelli
authors.forename: Silverio
authors.initials: S
authors.lastname: Tomao
authors.forename: Sergio
authors.initials: S
authors.lastname: Morini
mesh_terms: D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012074:Remission Induction / Q000379:methods; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology*; D013534:Survival