Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : EC13 - EC17 Full Version

Clinicopathological Study of Primary Gastrointestinal Lymphoma from a Tertiary Care Hospital in Southern India


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53661.16504
Kavita Gupta, Ranjini Kudva, Vidya Monappa, Pawan Nikhra

1. Associate Professor, Department of Pathology, Pacific Medical College and Hospital, Udaipur, Rajasthan, India. 2. Professor, Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India. 3. Associate Professor, Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India. 4. Associate Professor, Department of Pathology, Pacific Institute of Medical Sciences, Umarda, Rajasthan, India.

Correspondence Address :
Dr. Pawan Nikhra,
Flat no, B604, Archi Paradise Shobhagpura, Udaipur, Rajasthan, India.
E-mail: pawan.nikhra11@gmail.com

Abstract

Introduction: Primary Gastrointestinal Lymphoma (PGIL) is a heterogeneous disease in terms of patient characteristics, site, histologic types and treatment modalities. Although rare disease, it is the most common site for extranodal lymphomas accounting for 10-15% of all non-Hodgkin lymphoma and 30-40% of all extranodal lymphoma.

Aim: To study the different types of PGIL and its anatomic distribution along with its association with the clinical outcomes.

Materials and Methods: This was a retrospective study conducted in Department of Pathology of a tertiary care hospital, South India over a period of five years (2009 to 2013). A total of 61 cases of PGIL were identified, which included both resected surgical and endoscopic biopsy specimens. Histopathological classification of all cases was done based on morphologic and immunophenotypic criteria according to latest World Health Organisation (WHO) 2008 classification. Anatomic distribution of various types of lymphoma and associated clinical features were studied. The cases were then followed-up and survival analysis was also done. Descriptive statistical analysis methods were used to analyse the data. Overall Survival (OS) rates were calculated using Kaplan Meier method for 33 cases.

Results: There was predominance of men with peak incidence in 7th decade. Abdominal pain was the commonest presenting symptom seen in 77% of the cases. The most common site of involvement was stomach (41%) followed by large intestine (37.7%). All cases of primary GI lymphomas were of non-Hodgkin type. B cell lymphomas (n=54; 88.5%) were more frequent than T cell lymphomas (n=7; 11.5%). Diffuse Large B Cell Lymphoma (DLBCL) was the most common subtype accounting for 67.2% of cases (n=41) followed by MALT lymphoma (n=9; 14.8%). Follow-up was possible in 33 cases out of which 20 patients (32.8%) died with a median overall survival period of 13 months (95% CI, 7.8-18.2). The five-year overall survival (OS) for 33 patients who were followed-up was 67.2%.

Conclusion: Diagnosing PGILs correctly according to the recent WHO classification is important so that correct treatment protocols can be followed.

Keywords

Burkitt lymphoma, Extranodal, Lymphoepithelial, Mantle cell, Non-Hodgkin

Extranodal lymphoma is a well-known entity and is distinct from nodal lymphoma both in terms of treatment strategies and prognosis. It can involve any site but Gastrointestinal Tract (GIT) is the most common extranodal site involved by lymphoma accounting for 10-15% of all non-Hodgkin lymphoma and 30-40% of all extranodal lymphoma. Although lymphoma can involve any part of the gastrointestinal tract, the most common site is stomach followed by small intestine (1).

The PGILs are those which predominantly involve the alimentary tract or those with symptoms of GIT involvement on presentation (2). The criteria described by Dawson IM et al., can be used for distinction between primary and secondary GIT lymphomas, that include (1) absence of peripheral lymphadenopathy at the time of presentation; (2) lack of enlarged mediastinal lymph nodes; (3) normal total and differential white blood cell count; (4) predominance of bowel lesion at the time of laparotomy with only lymph nodes obviously affected in the immediate vicinity; and (5) no lymphomatous involvement of liver and spleen (3).

There is considerable variation in the literature with respect to the anatomic distribution and the various histopathological subtypes of PGIL worldwide (2),(3).

Aim of this study was to ascertain the histological subtypes and sites of PGIL diagnosed at present institution and to associate it with the clinical features and outcome.

Material and Methods

It was a retrospective study of cases of GIT lymphoma diagnosed over a period of five-years in Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India, from January 2009 to December 2013. The analysis of the data was done in April 2014. A total of 66 cases were identified out of which five were secondary GI lymphoma cases and rest 61 were PGIL. Ethical clearance was obtained from the Institutional Ethics Committee (IEC 333/2012).

Inclusion criteria: A total of 61 cases of PGIL were included in the study which comprised of both resected surgical and endoscopic biopsy specimens.

Exclusion criteria: Repeat biopsies or multiple biopsies from single patient were excluded from this study. Five cases of secondary GI lymphoma were also excluded based on Dawson’s criteria (3).

Computerised database of all the patients, histopathology slides, Immunohistochemistry (IHC) slides and medical records were analysed. All 61 PGIL cases were reviewed and reclassified according to recent WHO 2008 classification (4). Tissue sections were routinely processed and stained with Haematoxylin and Eosin (H&E). IHC was done judiciously depending on the H&E morphology and included CD3, CD20, CD79a, CD30, CD10, BCL 2, BCL 6, cyclin D1 and Ki-67. Due to financial constraints for IHC staining, it was not possible to classify and sub-classify some cases. Among the 61 cases of PGIL, follow-up was available only for 33 cases. The remaining patients of the total series were lost to follow-up during the five year interval.

Statistical Analysis

Statistical Package for the Social Sciences (SPSS) 12.0 software was used for the statistical analysis to determine the percentage frequency distribution of cases. OS was calculated using Kaplan Meier method for 33 cases.

Results

During five years, 61 PGILs were identified out of which 40 were men and 21 were women with men to women ratio of 1.9:1. Majority of PGIL were seen in elderly with a peak incidence in the seventh decade (median age - 46 years and range of 3-85 years) (Table/Fig 1).

The most common presenting symptom was abdominal pain (n=47; 77%) followed by vomiting (n=13; 21.3%). Few cases presented with other symptoms such as diarrhoea (n=11; 18%), weight loss (n=12; 19.7%), fever (n=4; 6.6%) and abdominal mass (n=5; 8.2%).

The most common site for PGILs was stomach (n=25;41%) followed by large intestine (n=23; 37.7%) and included caecum (7), colon (11) and rectum (5) (Table/Fig 2). Twelve cases (19.7%) of small intestinal lymphoma and included duodenum (4), jejunum (1) and ileum (7) were seen and only one case (1.6%) out of 61 cases primarily involved anal canal. No case of oesophageal lymphoma was found.

All cases of PGIL in present study were of non-Hodgkin type and predominantly were B cell lymphomas (n=54; 88.5%). T cell lymphomas were infrequent and constituted only 11.5% (n=7). DLBCL was the most common subtype accounting for 67.2% of cases (n=41). Second in frequency was low grade marginal zone lymphoma of Mucosa Associated Lymphoid Tissue (MALT) type (n=9; 14.8%) followed by T-cell lymphoma (n=7; 11.5%) (Table/Fig 3), (Table/Fig 4).

Most DLBCL (n=19) and extranodal marginal zone lymphoma of MALT type (n=4) were located in stomach. Five cases of MALT lymphoma had origin in large intestine which included colon and rectum. One case of follicular lymphoma involving the duodenum was seen.

Simultaneous Helicobacter pylori (H. pylori) infection was identified in seven (11.47%) cases of PGILs on histologic sections. Out of these four were DLBCL, two were MALT lymphoma and one was follicular lymphoma. Rest seven cases of MALT lymphoma were not associated with H. pylori infection.

Human Immunodeficiency Virus (HIV) infection was associated with 11.47% (n=7) of the PGILs. Five cases (71.4%) were B cell type lymphoma and rest two (28.6%) were T cell type. All B cell lymphomas were of DLBCL type (n=5, 71.42%).

The patients were followed-up for a range of 1-64 months. At the last documented follow-up maximum cases (n=28; 45.9) were lost to follow-up as they did not return back for treatment, 20 patients (32.8%) died due to various causes (Table/Fig 5) with a median overall survival period of 13 months (95% CI, 7.8-18.2). The most common cause of death in patients with PGILs in the present study was respiratory failure (n=7; 35%) followed by septic shock (n=4; 20%).

The five-year OS for 33 patients who were followed-up was 67.2%. The OS in patients with MALT lymphoma (88.9%) was longer than patients with DLBCL (68.3%) (p=0.062) but a significant association could not be established (Table/Fig 6). Similarly age, gender and site of origin of tumour also had no significant impact on overall survival in this study (Table/Fig 7), (Table/Fig 8).

Discussion

The PGIL is a heterogeneous disease in terms of patient characteristics, site, histologic types and treatment modalities. It accounts for 1-4% of all GI malignancies and is a rare disease (5). However it is the most common site for extranodal lymphomas. Non-Hodgkin lymphomas are the predominant type of lymphomas occurring in GIT although few cases of Hodgkin lymphoma have been reported in literature (6).

The distribution of age and sex in the study was similar to that observed in various other Indian and Western studies. Abdominal pain occurred as the most common symptom in almost every study and this study also confirmed the same (Table/Fig 9) (7),(8),(9),(10),(11).

The most common site of involvement was stomach (41%) in this study similar to other Indian and Western studies (Table/Fig 10) (7),(8),(10),(11),(12),(13). The second in frequency was large intestinal lymphoma in contrast to studies conducted by Arora N et al., Raina V et al., Singh DP et al., and Koch P et al., where gastric lymphoma was followed by small intestinal lymphoma (7),(8),(11),(12). Saber MM et al., similar to this study reported higher incidence of large bowel lymphomas than small bowel lymphomas and the explanation given was exclusion of paediatric patients where intestinal lymphoma predominate (13). In this study there were only four paediatric patients so the same explanation may hold true. However this may be a random variation due to limited number of cases. According to Koch P et al., ileocaecal and rectal lymphomas should be considered separately as they allow localised treatment and resection, especially in low grade lymphomas (12). In this study ileocaecal and rectal lymphomas accounted for 22.9% and 8.2% respectively.

Primary gastrointestinal T cell lymphomas are rare and occurred in 11.5% of patients, similar to other studies (Table/Fig 11) (7),(14),(15),(16),(17),(18),(19). The most common histological subtype in this study and various other studies (7),(13),(15),(18),(19) was DLBCL followed by MALT lymphoma. Higher incidence of MALT lymphoma (44%) was reported by Nakamura S et al., (17). They have attributed it to increase in H. pylori infection and advancement in diagnostic procedures. Rectal MALT comprised two out of nine cases (22.2%) in the present study. This was in concordance with study by Kohno S et al., (23%) (16). In a study by Geramizadeh B and Keshtkar Jahromi M conducted in Iran, small intestinal MALT lymphomas were more common than gastric MALT lymphomas (15). This is due to the prevalence of IPSID (Immunoproliferative Small Intestinal Disease) in Middle Eastern countries. There was not a single case of IPSID in this study which can be attributed to geographic variation or can be due to small sample size. Burkitt lymphoma accounted for only 3.2% in the study in contrast to studies by Arora N et al., (10%), Shukla K et al., (36%) and Kohno S et al., (11.2%) (7),(14),(16). This may be again due to less number of paediatric cases. 85.7% (n=6 out of 7 cases) of T cell lymphomas occurred in individuals more than 40 years and small intestine was the most frequent location. The term “Enteropathy Associated T cell Lymphoma” (EATL) was introduced by O’Farrelly C et al., in 1986 and its association with celiac disease was pointed out (20). In the present series one case of primary intestinal T cell lymphoma associated with tropical sprue was identified, however complete immunohistochemical work up was not done to further subtype it due to financial constraints. In this case, mucosa adjacent to primary tumour showed villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis. Apart from this, there was a single case of EATL type -1 in a 62 years old woman who presented with complaints of fever and loose stools. No histological evidence of celiac disease was noted but the tumour cells were CD3 positive and negative for CD4, CD 8, CD 56 and TCR-β.

Non-Hodgkin lymphomas represent a common malignancy in Acquired Immunodeficiency Syndrome (AIDS) patients. DLBCL is the most common primary GI lymphoma seen in association with AIDS (21). The other histological subtype seen in AIDS patients in this study was T cell lymphoma (n=2; 28.6%). The absence of lymphoblastic lymphomas, post-transplant lymphoproliferative disorder and plasmablastic lymphomas in this study can be attributed to rarity of these diseases and the smaller sample size.

Associated H. pylori infection was identified using Warthin-Starry stain on tissue section and was seen in only 11.5% (n=7) of cases. Out of these, four were DLBCL (57.1%), two were MALT lymphomas (28.57) and one was follicular lymphoma (14.3%). This was much less compared to various other studies. The low incidence of H. pylori in this study could be due to availability of only histopathological examination as serology was not available. Serology tests are mandatory when histology is negative as they increase the sensitivity (7). Detection of H. pylori is important as recommended strategy for management of early stage H. pylori positive gastric MALT lymphoma is eradication of bacilli with antibiotics (18).

The five-year overall survival in this study was 67.2%. It was higher than those documented in other studies (Table/Fig 12) (9),(13),(22),(23),(24). This can be due to various risk factors in different series of cases which is not taken into account while computing OS. Univariate analysis of factors considered as predictors of OS was done in this series of cases but none of them had significant impact on OS (Table/Fig 8). The OS in patients with MALT lymphoma (88.9%) was longer than patients with DLBCL (68.3%) (p=0.062) but a significant association could not be established. Conversely in this study the OS of patients with age group ≤60 years (67.5) was almost equal to those with age group >60 years (66.7). This can be attributed to more number of patients in age group ≤60 years (n=40) than age group >60 years. In future, a multicentric study with larger sample size is required to analyse statistical significance of the parameters affecting the overall survival of the patients.

Limitation(s)

Limitation of this study was small sample size as the data was obtained from a single tertiary care centre. Many patients were lost to follow-up as they did not return back for treatment, so significant association between OS and other factors, considered as predictors of OS could not be established.

Conclusion

The PGIL are rare and diagnosing them correctly according to the recent WHO classification is important so that correct treatment protocols can be followed. There is a close connection between chronic inflammation and lymphomas in gastrointestinal tract, so better understanding of its aetiology and molecular aspect is required. Information of the HIV status of the patient or any other type of immunodeficiency (post-transplant) should be available to avoid misdiagnosis of unusual lymphomas which have poorer prognosis than usual types.

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DOI and Others

DOI: 10.7860/JCDR/2022/53661.16504

Date of Submission: Jan 01, 2022
Date of Peer Review: Feb 04, 2022
Date of Acceptance: Mar 19, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 05, 2022
• Manual Googling: Mar 16, 2022
• iThenticate Software: Mar 18, 2022 (24%)

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