Primary small intestinal lymphoma: a clinical analysis of 68 cases

Objective:To investigate the clinicopathological characteristics, treatment, prognostic factors of primary small intestinal lymphoma (PSIL).
Methods:The clinical data of 68 patients with PSIL who were admitted to the Cancer Hospital of Tianjin Medical University from November 1999 to July 2009 were retro spectively analyzed. The diagnostic workup before operation included abdominal ultrasound, computed tomography (CT) scan of the abdomen, small intestinal barium radiography, endoscopy examination and laboratory examination. The patients with local PSIL underwent radical surgery, patients who were not eligible for radical surgery received palliative treatment, and then accurate staging was done according to Ann Arbor system for gastrointestinal lymphoma, and chemotherapy was applied according to the condition of patients. The patients were followed up by letters, telephone and outpatient care till July 2012. Factors might have influence on the prognosis were analyzed by the Kaplan Meier method and Log rank test. COX regression model were used for univariate and multivariate analysis, respectively.
Results:The major symptoms of PSIL included abdominal pain (69.1%, 47/68) and weight loss (29.4%, 20/68). All of the 68 patients underwent small intestinal barium radiography and endoscopy examination, and 15 and 11 cases were definitely diagnosed as with PSIL. Abdominal mass were detected by abdominal ultrasound in 38 of 45 cases. Positive results were found in 30 cases by CT and 5 cases by positron emission tomography (PET) CT. PSIL mainly involved ileum (73.5%, 50/68), 13 PSILs were located at the jejunum and 5 at the duodenum. Of all the 68 patients, 64 were with B cell subtype PSIL and 4 were with T cell subtype PSIL. Most tumors belonged to stagesⅠ and Ⅱ (66.2%, 45/68). All of the 68 patients were treated with surgical procedure, including 51 patients received radical resection and 17 patients had palliative resection. After operation, 4 -Ⅱ) and surgical resection plus chemotherapy are independent prognostic factors for better survival.