Radiographic Findings of Primary B-Cell Lymphoma of the Stomach: Low-Grade Versus High-Grade Malignancy in Relation to the Mucosa-Associated Lymphoid Tissue Concept
Mi-Suk Park1,2,
Ki Whang Kim1,2,
Jeong-Sik Yu1,2,
Chanil Park3,
Jai Keun Kim4,
Sang-Wook Yoon1,2,
Kwang-Hun Lee1,2,
Young Hoon Ryu1,
Haeryoung Kim3,
Myeong-Jin Kim1,
Jong Tae Lee1 and
Hyung Sik Yoo1
1 Department of Diagnostic Radiology, Yonsei University College of Medicine,
134, Shinchon-dong, Seodaemun-Ku, Seoul 120-752, Korea.
2 YongDong Severance Hospital, 146-92 Dokok-Dong, Kangnam-Ku, Seoul 135-270,
Korea.
3 Department of Pathology, Yonsei University College of Medicine, Seoul 120-752,
Korea.
4 Department of Diagnostic Radiology, Ajou University College of Medicine,
Suwon, Kyounggi-Do, Korea.
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Fig. 1A. —Low-grade gastric mucosa-associated lymphoid tissue lymphoma
with fine mucosal nodularity in 56-year-old man who had been treated with
antibiotics for Helicobacter pylori eradication and had attained
complete remission. Spot radiograph of upper gastrointestinal tract shows
innumerable nodules of varied sizes that could be mistaken for areae gastricae
with coarse pattern.
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Fig. 2B. —Low-grade gastric mucosa-associated lymphoid tissue lymphoma
with fine mucosal nodularity in 56-year-old man who had been treated with
antibiotics for Helicobacter pylori eradication and had attained
complete remission. Endoscopic image reveals diffuse fine nodularity in
gastric body.
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Fig. 2A. —58-year-old man with low-grade gastric mucosa-associated
lymphoid tissue lymphoma with ulcer. Spot radiograph from double-contrast
study shows barium collection with vague marginal nodularity
(arrows), which can be easily missed at first glance.
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Fig. 2B. —58-year-old man with low-grade gastric mucosa-associated
lymphoid tissue lymphoma with ulcer. Compression radiograph of upper
gastrointestinal examination shows large shallow ulcer with nodularity at
margin (arrows) and base (arrowheads) of ulcer in posterior
wall of gastric body.
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Fig. 2C. —58-year-old man with low-grade gastric mucosa-associated
lymphoid tissue lymphoma with ulcer. Low-power photomicrograph shows lymphoid
cells (arrows) mainly located at lamina propria and submucosal layer.
Note diffuse, superficial spreading pattern of lymphoid cells.
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Fig. 3. —44-year-old woman with low-grade gastric mucosa-associated
lymphoid tissue lymphoma. Spot radiograph of upper gastrointestinal tract
shows multiple nodules (black arrows) of varied size and shallow
depression in posterior wall of gastric body. Note convergent rugae (white
arrows) that project to multiple points.
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Fig. 4A. —48-year-old woman with low-grade gastric mucosa-associated
lymphoid tissue lymphoma with combined pattern. Spot radiograph of upper
gastrointestinal tract shows discrete ulcer (u) with convergence of
surrounding rugae (arrows) in posterior wall of gastric body, which
looks like early gastric carcinoma.
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Fig. 4B. —48-year-old woman with low-grade gastric mucosa-associated
lymphoid tissue lymphoma with combined pattern. Spot radiograph shows multiple
nodules (arrows) of varied sizes in large area of gastric body and
antrum, which are located distal to ulcer (U) in A.
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Fig. 5A. —64-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with large mass. Spot radiograph of upper
gastrointestinal tract shows large submucosal mass (arrows) at lesser
curvature side of gastric body and antrum.
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Fig. 5B. —64-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with large mass. Low-power photomicrograph shows
large mass-forming malignant cell cluster (M) involving entire layers of
stomach with serosal penetration.
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Fig. 6A. —58-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with diffuse infiltration. Spot radiograph of upper
gastrointestinal tract shows diffuse luminal narrowing with marked fold
thickening of gastric fundus and body.
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Fig. 6B. —58-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with diffuse infiltration. Contrast-enhanced
transverse CT scan shows encircling, markedly thickened gastric wall
(arrows).
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Fig. 7A. —72-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with deep ulcer. Spot radiograph of upper
gastrointestinal tract shows large, deep ulcer (u) with surrounding mound.
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Fig. 7B. —72-year-old man with high-grade gastric mucosa-associated
lymphoid tissue lymphoma with deep ulcer. Low-power photomicrograph shows
large ulcer (thick arrow) with malignant cell nests (thin
arrows) at margin of ulcer. Histopathologic examination found nests were
composed of large blast-transformed cells (not shown).
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Fig. 8. —Bar chart shows mean thickness of gastric wall measured on CT
correlated with depth of invasion found on surgically resected specimen. Note
that the deeper the invasion depth, the thicker the wall.
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Copyright © 2002 by the American Roentgen Ray Society.
