Summary
Definition
History and exam
Key diagnostic factors
- history of Helicobacter pylori gastritis
- history of autoimmune disorder
- increasing age
- dyspepsia
- epigastric discomfort
- skin lesions
- red eye ± photophobia
- painless proptosis, diplopia, motility disturbances of the eye, ptosis, decreased vision
Other diagnostic factors
- nausea and/or vomiting
- GI bleeding
- fever
- night sweats
- weight loss
- shortness of breath, hemoptysis, cough
- salivary gland swelling
- thyroid swelling
- breast lump
- focal neurologic deficits
- lymphadenopathy
Risk factors
- Helicobacter pylori infection
- increasing age
- autoimmune diseases
- Chlamydia psittaci infection
- Campylobacter jejuni infection
- Borrelia burgdorferi infection
- hepatitis C virus infection
- HIV infection
Diagnostic tests
1st tests to order
- CBC
- blood smear
- upper GI endoscopy
- biopsy of affected tissue
- staging CT scan
- H pylori serology
- H pylori stool antigen test
- LFTs
- basic metabolic panel
Tests to consider
- bone marrow biopsy
- immunohistochemistry
- reverse transcriptase polymerase chain reaction (RT-PCR) or fluorescence in situ hybridization (FISH)
- immunoglobulin gene rearrangement studies
- serum electrophoresis
- serum LDH
- serum beta-2 microglobulin
- 18F-fluorodeoxyglucose (FDG) PET/CT scan
- endoscopic ultrasound of the stomach
- double contrast radiograph of the GI tract
- lower GI endoscopy
- endoscopic otolaryngology
- CT scan of salivary glands
- MRI orbit
- hepatitis C serology
- hepatitis B serology
- HIV serology
- multiple-gated acquisition scan (MUGA)
- echocardiography
- ethylenediamine tetraacetic acid glomerular filtration rate (EDTA GFR)
Treatment algorithm
low-grade localized gastric: Helicobacter pylori-positive
low-grade localized gastric: Helicobacter pylori-negative
low-grade advanced gastric
low-grade nongastric
high-grade histologic transformation: gastric or nongastric
Contributors
Authors
Christopher McNamara, MBBS (Hons), FRACP, FRCPA, FRCPath
Consultant Haematologist
Royal Free Hospital
London
UK
Disclosures
CM declares that he has no competing interests.
Acknowledgements
Dr Christopher McNamara wishes to gratefully acknowledge Dr Rahul Joshi, a previous contributor to this topic. RJ declared that he had no competing interests. Unfortunately, we have since been made aware that Dr Rahul Joshi is deceased.
Peer reviewers
Markus Raderer, MD
Professor of Medicine
Department of Internal Medicine I
Division of Oncology
Medical University Vienna
Austria
Disclosures
MR is an author of a number of references cited in this topic.
Alan Lichtin, MD
Staff Hematologist
Cleveland Clinic Taussig Cancer Center
Cleveland
OH
Disclosures
AL declares that he has no competing interests.
Ian Chau, MD
Consultant Medical Oncologist
Royal Marsden Hospital
Sutton
UK
Disclosures
IC has been reimbursed by Roche Products, the manufacturer of rituximab, for attending several conferences. IC has also served on advisory boards and received honorarium for giving presentations for Roche Products. IC has received research funding from Novartis to conduct academic studies in the treatment of colorectal cancer.
Differentials
- Mantle cell lymphoma
- Small lymphocytic lymphoma
- Follicular lymphoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: B-cell lymphomas
- Marginal zone lymphomas
More GuidelinesPatient information
Non-Hodgkin lymphoma
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