title: Clonal immunoglobulin heavy chain and T-cell receptor γ gene rearrangements in primary gastric lymphoma.
abstract: OBJECTIVE
  To study the diagnostic value of immunoglobulin heavy chain (IgH) and T-cell receptor γ (TCR-γ) gene monoclonal rearrangements in primary gastric lymphoma (PGL).
  
  
  METHODS
  A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011. The patients were divided into three groups (a PGL group, a gastric linitis plastica group, and a benign gastric ulcer group) based on the pathological results (gastric mucosal specimens obtained by endoscopy or surgery) and follow-up. Endoscopic ultrasonography (EUS) and EUS-guided biopsy were performed in all the patients. The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.
  
  
  RESULTS
  EUS and EUS-guided biopsy were successfully performed in all 48 patients. In the PGL group (n = 21), monoclonal IgH gene rearrangements were detected in 14 (66.7%) patients. A positive result for each set of primers was found in 12 (57.1%), 8 (38.1%), and 4 (19.0%) cases using FR1/JH, FR2/JH, and FR3/JH primers, respectively. Overall, 12 (75%) patients with mucosal-associated lymphoid tissue lymphoma (n = 16) and 2 (40%) patients with diffuse large B-cell lymphoma (n = 5) were positive for monoclonal IgH gene rearrangements. No patients in the gastric linitis plastica group (n = 17) and only one (10%) patient in the benign gastric ulcer group (n = 10) were positive for a monoclonal IgH gene rearrangement. No TCR-γ gene monoclonal rearrangements were detected. The sensitivity of monoclonal IgH gene rearrangements was 66.7% for a PGL diagnosis, and the specificity was 96.4%. In the PGL group, 8 (100%) patients with stage IIE PGL (n = 8) and 6 (46.1%) patients with stage IE PGL (n = 13) were positive for monoclonal IgH gene rearrangements.
  
  
  CONCLUSIONS
  IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.
authors.affiliation: Guo-Dong Shan, Feng-Ling Hu, Ming Yang, Hong-Tan Chen, Wen-Guo Chen, Yun-Gui Wang, Li-Hua Chen, You-Ming Li, Guo-Qiang Xu, Department of Gastroenterology, the First Affiliate Hospital, School of Medicine, Zhejiang University, Hangzhou 321000, Zhejiang Province, China.
authors.forename: Guo-Dong
authors.initials: GD
authors.lastname: Shan
authors.forename: Feng-Ling
authors.initials: FL
authors.lastname: Hu
authors.forename: Ming
authors.initials: M
authors.lastname: Yang
authors.forename: Hong-Tan
authors.initials: HT
authors.lastname: Chen
authors.forename: Wen-Guo
authors.initials: WG
authors.lastname: Chen
authors.forename: Yun-Gui
authors.initials: YG
authors.lastname: Wang
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Chen
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Li
authors.forename: Guo-Qiang
authors.initials: GQ
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D019160:Endosonography; D005260:Female; D005773:Gastroscopy; D015321:Gene Rearrangement; D019675:Genes, T-Cell Receptor gamma; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D008223:Lymphoma / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000235:genetics / Q000276:immunology* / Q000473:pathology; D055815:Young Adult
chemical_list: D007143:Immunoglobulin Heavy Chains
keywords: Endoscopic biopsy specimen; Gene rearrangement; Immunoglobulin heavy chain; Primary gastric lymphoma; T-cell receptor γ
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