PRIMARY GASTROINTESTINAL NON-HODGKINS-LYMPHOMAS - CLINICAL PRESENTATION AND RESULTS OF TREATMENT

During the period of 1978-1988, 36 patients were treated for primary g astrointestinal non-Hodgkin's lymphoma (PGIL) at the Second Department of Surgery, Helsinki University Central Hospital. There were 16 gastr ic, 15 small intestinal, four large bowel lymphomas, and one case of d iffuse multiple lymphomatous polyposis (MLP) of the gastrointestinal t ract. Most frequently the disease occurred in middle-aged patients equ ally in both sexes. Symptoms were nonspecific. Abdominal pain was the most common symptom occurring in 30 patients (83 %), followed by nause a in 17 patients (47 %). Fever occurred in seven patients (20 %). Blee ding occurred in ten patients (28 %), obstruction in five (14 %), and perforation in three patients (8 %). An abdominal mass was felt in ten patients (28 %). Radiological findings were mostly non-specific but s uggested malignant tumour. A definitive diagnosis was difficult to con firm by endoscopic examination. Thirty-five patients underwent surgery , curative in 19 (12 gastric, five small intestine lymphomas (SIL), tw o large intestine lymphomas (LIL)), and palliative in 12 patients (two gastric, eight SIL, one LIL, and one case of MLP). One patient (gastr ic) underwent exploration and three had other procedures (two SIL, one LIL). 89 % of the patients who had a curative resection Survived five years, compared with 28 % of those who had palliative resection. The stage of the disease was a very important prognostic factor: the five- year survival was 92 % for patients with Stage I disease, while none o f the patients with Stage IV disease survived five years. Also, adjuva nt therapy was a statistically significant variable affecting survival , and the site of the tumour. Patients with gastric lymphoma had bette r survival than those with small and large intestinal lymphoma.