MALT-Type gastric lymphoma. Séméiologie Échoendoscopique
Summary
Endoscopic ultrasound is among all the most accurate and sensitive imaging techniques for the locoregional staging of MALT-type gastric lymphoma. However, some problems remain: The standard degold deficiency, the discrepancies in the literature data, the need for a "definition" of endoscopic séméiologie. The solution should be found in uneConférence of Consensus bringing together as many operators as possible.
Keywords
Aspect Endosonographique Classification TNM Endoscopic (EE) Gastric lymphoma Type staging malt of Ann Arbor modified malt type gastric lymphoma. Endoscopic Ultrasound Semiotics
Summary
Endoscopic ultrasonography is, among all the imaging techniques, the most accurate and sensitive in locoregional staging of gastric MALT lymphoma.
But Yet some problems are still open: the lack of agold standard, the disagreement of the data in literature, the necessity "to set up" endoscopic ultrasound semeiotics.
The solution could be found in AConsensus Conference with the participation of as many operators of the field as possible.
Key-Words
Endoscopic ultrasound Aspects Endoscopic ultrasonography (had) gastric malt lymphoma Modified Ann Arbor staging TNM staging malt type gastric lymphoma. Endoscopic Ultrasound Semeiotics
Rt ~ SUMI
Endoscopic ultrasound is among all the most pr6cise and sensitive imaging techniques for staging Locor6gionale
MALT-Type gastric lymphoma. However, some probl6mes remain pos6s: the lack of standard gold, the discrepancies
Of the donn6es of the Litt6rature, the n6cessit6 of a < ~ d6finition of the endoscopic s6m6iologie. The solution should be trouv6e in a Conference
Consensus R6unissant as many op6rateurs as possible.
SUMMARY
Endoscopic ultrasonography is, among all the imaging techniques, the most accurate and sensitive in locoregional staging of gastric
Lymphoma MALT.
But Yet some problems are still open: the lack of a gold standard, the disagreement of the data in literature, the necessity ~ to set up,, endoscopic
Ultrasound semeiotics.
The solution could be found in a Consensus Conference with the participation of as many operators of the field as possible.
Introd Introduction
The term MALT type lymphoma (Mucosa
Associated Lymphoid Tissue) a 6t6 introduced in 1984
[1]. Subsequently, he 6t6 recognized as a ENTIT6
Distinct, with histological sp6cifiques caract6ristiques
and biological, ETA 6T6 included in the classification
REAL (Revised European-American Lymphoma)
[2-4].
This tumor is most often situ6e in the stomach,
OFA She repr6sente 2? has 8% of gastric n6oplasies.
It is fr6quemment associ6e h infection
by Helicobacter pylori (H. pylori) [5]. Many
6tudes [6-11] have MONTR6 with percentages
Variable, that the only th6rapie that
61iminer Bact6rie (IPP + antibiotics) could be
Also d6terminer the r6gression of primary lymphoma
Type of gastric MALT at the Pr4coce stage. These
R6sultats have allowed to have an option Th6rapeutique
Diff6rente of Chimioth6rapie, Radioth6rapie and
Surgery and have more soulign6 the N6CESSIT6
6valuer of a way more pr6cise these patients in order to
Offer them a th6rapeutique more sp6cifique.
Among the Diff6rentes imaging techniques utilis6es
To this end, the 6choendoscopie (EE) is
This day, the most pr6cise for the staging Locor6gionale
Gastric n6oplasies [12-16].
Material and methods
In the panel of instrumentation d6di6e/a I'EE,
The Olympus radial 6choendoscopes have 6t6 tr6s
Utilis6s for the 6tude of this pathology [10-20] and
Up to this day the best instruments for
The 6tude of the gastric wall and the ad6nopathies.
Other instruments such as mini-probes
Radial could be utilis6s in the follow up of the
Patients with low-grade lymphoma (staging
PR6-Th6rapeutique in grade IE1) according to the classification
of Ann Arbor modifi6e by Musshoff [21].
With this proc6dure, it is possible to R6aliser
With a single endoscopic intubation, the Endosonographie
And the pr61 biopsy dirig6s to the
More suspicious 6chographiquement areas. Compliance
The patient should be better in
Tir6s H part: D R T. FEDERICI, U.O. Gastroenterologia IRCCS, Ospedale < ~ Casa Sollievo della Sofferenza ~ > Viale Cappuccini 1, 71013 S.
Giovanni Rotondo (FG) (Italy).
CL ~ s: endosonographique aspect, TNM classification, 6choendoscopie (EE), MALT-Type gastric lymphoma, ANN staging
Arbor modifi6e.
Key-Words: Endoscopic ultrasound aspects; Endoscopic ultrasonography (had); Gastric MALT lymphoma; Modified Ann Arbor staging;
TNM staging.
Acta Endoscopica Volume 33-N ~ 1-2003 45 considdrant the n6cessit6 of having to do several
Contr61es it6ratifs darts time.
The r6sultats of the litt6rature on the use of
Mini-probes are still limit6s and the indications discut6es
[22, 23]. Some authors [24] have doubts
On their use in the staging of tumors
Whereas others [25] believe that they are
Can be adapt6es in the staging of gastric cancers
Pr6coces that will be trait6s by Mucosectomie
Endoscopic (EMR). Other 6tudes are n6cessaires
To validate this hypoth6se. In
Doubtful cases, an EE with radial instrumentation
Can of any way utilisde.
Another possibilit6 is to be able to make a 6tude
COMBIN6E with a single grfice instrument to the new
Vid6o-6choendoscopes Radial (Olympus, Pentax),
That are tr6s manageable and innovative. These instruments
Not only allow the endoscopic examination to R6aliser
and r6aliser of stomach biopsies
(As with the vid6o-gastroscopes) but still
R6aliser FEE with fr6quences diff6rentes between 5 and
20 MHz in a single review. While instrumentation
For the 6choendoscopie had a great 6volution
These latest ~ Res ann6es, the modalit6 of ex6cution
The EA review is rest6e practically inchang6e: the
Pr6paration of the patient (consent INFORM6, D6cubitus,
S6dation) and the exdcution of the examination are always
~ The current time, as indicated by the
Ann6es pass6es [12-14]. During a endosonographique review
Of the normal stomach, it is possible to visualize
The 5 layers of the wall [26], the structures of the
P6ri-Visc6rales such as the ad6nopathies that
In the field of exploration of the instrument.
RE, S UL states
Endoscopic Aspects
The diagnosis of Gastric lymphoma type
MALT is NETHERLANDS6 on histological examination and
Immuno-Histo-Chemical [27] endoscopic biopsies.
Often the disease is multifocal and it can
Coexist at the location of the 16sions of Diff6rents ranks.
DEGR6 low-MALT type lymphoma
Can sometimes 6voluer to high-grade lymphoma
[28]. The disease can 6tendre the whole stomach but
Most often it is localis6e in the Den, in the
Body or at the level of these two locations. The appearance
Endoscopic pr6sente of way trbs variable,
4 aspects can be met [29]: 1) 16sions Polyweight
[30]; 2) 6paississement of folds (g6ants folds)
with or without 6rosions; 3) 6rosions of the mucosa,
Often multiple or a granular appearance with a
6ryth6me Irr6gulier; 4) Multiple ulc6res, sometimes
Unique Ulc6re, plan and Irr6gulier.
In order to r6aliser a diagnosis and follow up PR6-
CIS, taking into account the VARIABILIT6, the MULTIFOCALIT6
And sometimes of the existence of Ldsions discrbtes, he
is n6cessaire to make an endoscopic mapping
Exact (location, number, dimensions and type of
16sion) of the multiple biopsy pr616vements of
Various suspicious areas.
Endosonographiques Aspects
In the two moiti6 of Ann6es 80, the Premiters
6tudes [31, 32] d6crivaient the endosonographiques aspects
Lymphoma as 6tant a 16sion
Hypo6chog ~ NE that d6terminait a destruction of
The normal architecture of the wall and associated
Lymph node invasion.
Subsequently, 3 endosonographiques aspects have 6T6
D6crits: 1) Protrusion polypo'fde in the light
Digestive 2) Infiltration Hypo6chog ~ NE localis6e;
3) Infiltration Hypo6chog ~ No diffuse, 6tendue and longitudinal
of the gastric wall.
In the following ann6es, other authors [12, 13]
Donn6 a more pr6cise description of the aspects
6choendoscopiques of this disease. In particular
Suekane et al. [12] have D6MONTR6 that the donn6es of
The Endosonographie is corr61aient tr6s well with the
Endoscopic, macroscopic and histological donn6es.
They have Distingu6 4 aspects endosonographiques
: 1) Superficial flooding (6paississement
Of the 2nd layer, the third layer or the two
Layers); 2) flooding largely infiltrating
(6paississement Trans-mural 6tendu and Irrdgulier of the
Wall); 3) protrusive mass (mass hypo6chog ~ NE
localis6e with well d6finies situ6es margins in the
2nd or 3rd or 4th layer); 4) The mixed type (combination
Aspects 1 and 3). In their exp6riences the
Patients with endosonographiques aspects 1 and 2
Prdsentaient h histological examination, lymphoma
MALT type. Like Signal6 pr6c6demment,
The
Possibilit6 of the simultan6e existence of lymphoma
High grade and low grade MALT type in
A M ~ Me 16sion or in a diff6rente 16sion must
~ Tre envisag6e. This possibilit6 sugg6re better
R66valuer positive Hp patients with R6pondu
Treatment of 6radication and in which no
R6gression of the MALT type lymphoma is
OBSERV6 apr6s a period follow-up ad6quate (6-
18 months according to the diff6rents authors).
Some authors have soulign6 the importance of
Measurement of the 6paisseur of the gastric wall, another
Important to Diff6rencier a wall
of a pathological wall [10, 17]. These
Considbrent authors as the mucosa (1 E and 2 E
Layer) Pr6sente a pathological 6paississement
When this is > ~ 3mm.
They consider 6galement a 6paississement >
5 mm from the totalit6 of the wall as pathological.
A focal modification of the 6paisseur of each
Layer, within the 6paississement of 5 ram, 6tait
6galement considdr6e as pathological [10].
In the monitoring by 6choendoscopie, the D6couverte
of a 6paississement of the gastric wall, in
The absence of histological positivit6 for lymphoma
Type MALT, must make consid6rer the persistence
of the disease. By cons6quent, it must impose
The rdalisation of new biopsies [17].
On the other hand, it is possible to d6couvrir the 6choendoscopie
A normal gastric wall having ndanmoins
A positive biopsy for type lymphoma
MALT [36].
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