Primary Gastric Malignant Lymphoma and Pseudolymphoma

Abstract

Twenty-seven lymphoreticular lesions previously diagnosed as primary gastric malignant lymphoma were followed as long as twenty years. Histopathologic criteria of Smith and Helwig for pseudolymphoma were found to distinguish twelve tumors which failed to metastasize or cause death. These cases had prolonged gastric symptoms, and free hydrochloric acid was consistently present. They were characterized histopathologically by a mixed inflammatory infiltrate with reaction centers and scar tissue in fields far removed from peptic ulcer, and lack of local lymph node metastases. True malignant lymphomas generally pursued a shorter preopertive clinical course, in terms of months rather than years, and achlorhydria was frequently present. True lymphomas and pseudolymphomas are clinically difficult to separate from one another and from other gastric diseases. Histologic differential diagnostic criteria are stressed.