title: Endoscopic and clinical analysis of primary T-cell lymphoma of the gastrointestinal tract according to pathological subtype.
abstract: OBJECTIVE
  Little is known about the clinicopathological characteristics of primary gastrointestinal T-cell lymphomas (PGITL). This study evaluated the clinical and endoscopic features of the pathological subtypes of PGITL.
  
  
  METHODS
  Forty-two lesions in 36 patients with PGITL were assessed, including 15 enteropathy-associated T-cell lymphomas (EATL), 13 peripheral T-cell lymphomas (PTCL), 10 NK/T-cell lymphomas (NK/TL), and four anaplastic large cell lymphomas (ALCL).
  
  
  RESULTS
  PTCL occurred more frequently in the stomach and duodenum and NK/TL more frequently in the small and large intestines (P = 0.009). The endoscopic features of the four subtypes were similar (P = 0.124). Fifteen of 41 lesions (36.6%) were Epstein-Barr virus (EBV) positive, with NK/TL more likely to be EBV positive than the other types (P < 0.001). First endoscopy and first computed tomography (CT) scan indicated that 65.4% and 51.4% of the lesions, respectively, were malignant, and that 43.2% and 42.3%, respectively, were GI lymphomas. The two modalities together correctly diagnosed about half of the lesions before biopsy. Intestinal perforation was associated with small bowel location (P < 0.001) and infiltrative type (P = 0.009), and was more common in NK/TL than in the other subtypes (P = 0.015). Multivariate analysis showed that higher international prognosis index (P = 0.008) and the presence of complications (P = 0.006) were associated with poor prognosis. Survival was poorer in patients with small bowel lesions than with lesions at other locations (P = 0.048).
  
  
  CONCLUSIONS
  The four main pathological types of PGITL differed in clinical characteristics. As PGITL was often not diagnosed by initial endoscopic or radiological examination, a high index of suspicion is necessary to ensure its early diagnosis.
authors: Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Do Hoon
authors: DH
authors: Kim
authors: Danbi
authors: D
authors: Lee
authors: Jeong Won
authors: JW
authors: Kim
authors: Jooryung
authors: J
authors: Huh
authors: Seong Ho
authors: SH
authors: Park
authors: Hyun Kwon
authors: HK
authors: Ha
authors: Cheolwon
authors: C
authors: Suh
authors: Soon Man
authors: SM
authors: Yoon
authors: Kyung-Jo
authors: KJ
authors: Kim
authors: Kee Don
authors: KD
authors: Choi
authors: Byong Duk
authors: BD
authors: Ye
authors: Jeong-Sik
authors: JS
authors: Byeon
authors: Ho June
authors: HJ
authors: Song
authors: Hwoon Yong
authors: HY
authors: Jung
authors: Suk-Kyun
authors: SK
authors: Yang
authors: Jin-Ho
authors: JH
authors: Kim
authors: Seung-Jae
authors: SJ
authors: Myung
mesh_terms: D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D016399:Lymphoma, T-Cell / Q000145:classification* / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D014057:Tomography, X-Ray Computed
keywords: clinical; endoscopic; gastrointestinal tract; pathological subtype; primary T-cell lymphoma