Endoscopic differential diagnosis of the gastritis-like form of primary non-Hodgkin’s lymphomas and neuroendocrine tumors of the stomach

Abstract

Background. The gastritis-like form of primary non-Hodgkin’s lymphomas (NHL) of the stomach is the rarest macroscopic variant of malignant neoplasms of the stomach, endoscopically resembling inflammatory changes in the mucous membrane and, in single observations, polypoid and flatly elevated forms of neuroendocrine tumors (NET) of the stomach. Despite the great experience gained in the diagnosis and treatment of primary NHL of the stomach and NET of the stomach, in clinical practice there are examples that cause difficulties in the correct interpretation of the endoscopic picture and the timely diagnosis.Aims. To analyze the data of a comprehensive endoscopic examination of patients with diagnoses of a gastritis-like form of primary NHL and NET of the stomach, and to identify the main differentially significant endoscopic criteria characteristic of each individual type of neoplasia.Materials and methods. In a prospective study conducted at the FSBI “N.N. Blokhin national medical Research Center of Oncology” of the ministry of Health of Russia in the period from 2017 to 2022, data from endoscopic and morphological studies of 69 patients with gastritis-like malignancies were analyzed. All patients underwent a comprehensive endoscopic examination of the upper gastrointestinal tract – esophagogastroduodenoscopy using all clarifying examination methods (narrow-spectrum mode, examination in magnification mode, a combination of narrow-spectrum examination with magnification mode), accompanied by the taking of biopsy material for the purpose of morphological verification of the diagnosis, and endosonographic study.Results. According to the results of a morphological study, the diagnosis of primary NHL of the stomach was confirmed in 38 patients (55.1 %), NET of the stomach – in 31 patients (44.9 %). A change in diagnosis based on the results of a morphological study occurred in 3 (4.3 %) of 69 (100 %) patients. The sensitivity and diagnostic accuracy of complex endoscopic examination were higher compared to endoscopic examination in white light mode, and amounted to 92.11, 95.65 and 13.16 %, 52.17 %, respectively.Conclusion. for a correct assessment of the endoscopic picture, it is necessary to conduct a comprehensive endoscopic examination using all clarifying diagnostic methods, which shows greater sensitivity and specificity compared to examination in white light mode.