Histologic changes of the gastric mucosa associated with primary gastric lymphoma in endoscopic biopsy specimens

Context.-Recently, we have observed intestinal metaplasia, atrophy, and dys plasia in the mucosa adjacent to primary gastric lymphoma (PGL) in gastrect omy specimens. Objective.-To determine the frequency and type of epithelial disorders at t he histopathologic level in the mucosa adjacent to PGL in endoscopic specim ens. Design.-We studied 54 endoscopic biopsies from patients harboring PGL. We s earched for the following morphologic changes in the gastric mucosa: intest inal metaplasia; atrophy; dysplasia; epithelial erosion; and atypical regen eration of the glandular epithelium. Other nonepithelial findings such as l ymphoid follicles, Helicobacter pylori, and lymphoma grade, were also recor ded. For comparative purposes, 50 endoscopic biopsies with gastric adenocar cinoma and 50 biopsies with chronic gastritis associated with H pylori infe ction were also studied. Results-The 54 biopsies included 28 (52%) low-grade and 26 (48%) high-grade PGLs. We found intestinal metaplasia in 32 biopsies (59%), atrophy in 20 b iopsies (37%), dysplasia in 2 biopsies (4%), erosion of the epithelium in 3 3 biopsies (61%), and atypical regenerative changes of the glandular epithe lium in 10 biopsies (19%). Lymphoid follicles were found in 21 biopsies (39 %), and H pylori was demonstrated in 31 biopsies (57%). When groups were co mpared, the frequency of epithelial changes in biopsies from patients with PGL and adenocarcinoma was similar. Intestinal metaplasia or atrophy were p resent in only 10% of biopsies from patients with gastritis, and dysplastic glands were not identified. Conclusions.-Biopsies from patients with PGL showed chronic damage of the g astric mucosa at diagnosis, including precancerous conditions. Intestinal m etaplasia and atrophy were among the most frequent disorders, but dysplasia was also occasionally present Endoscopists and pathologists must be acquai nted with such changes and look for them in the initial biopsy, as well in subsequent samples. This practice is particularly important when reviewing biopsies from patients with low-grade mucosa-associated lymphoid tissue (MA LT)-lymphomas who are eligible for eradication treatment for H pylori.