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Lymphoma is the second most common gastric malignancy, accounting for 3 6% of gastric cancers More than 95% of these are non-Hodgkin s B cell lymphomas Gastric lymphomas may be primary (arising from the gastric mucosa) or may represent a site of secondary involvement in patients with nodal lymphomas About 60% of primary gastric lymphomas are believed to arise from mucosa-associated lymphoid tissue (MALT) Distinguishing advanced primary gastric lymphoma with adjacent nodal spread from advanced nodal lymphoma with secondary gastric spread can be problematic Because the prognosis and treatment of primary and secondary gastric lymphomas are entirely different, the distinction is important B cells of nodal origin may be distinguished from those derived from MALT (CD19 and CD20 positive) Infection with H pylori may be an important risk factor for the development of primary gastric lymphoma Chronic infection with H pylori causes an intense lymphocytic inflammatory response that may lead to the development of lymphoid follicles Over 85% of low-grade primary gastric lymphomas and 40% of high-grade lymphomas are associated with H pylori infection The risk of developing lymphoma is increased sevenfold in patients with chronic H pylori infection It is hypothesized that chronic antigenic stimulation may result in a monoclonal lymphoproliferation that may

Gastric carcinoids are rare neuroendocrine tumors that make up less than 1% of gastric neoplasms They may occur sporadically or secondary to chronic hypergastrinemia that results in hyperplasia and transformation of enterochromaffin cells in the gastric fundus Sporadic carcinoids account for 20% of gastric carcinoids Most are solitary, over 2 cm in size, and have a strong propensity for metastatic spread Most sporadic carcinoids already have carcinoid syndrome and hepatic or pulmonary metastatic involvement at initial presentation Localized sporadic carcinoids should be treated with radical gastrectomy The majority of carcinoids caused by hypergastrinemia occur in association with either pernicious anemia (75%) or

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Zollinger-Ellison syndrome (5%) Carcinoids associated with Zollinger-Ellison syndrome occur almost exclusively in patients with MEN 1, in which loss of 11q13 has been reported Carcinoids caused by hypergastrinemia tend to be multicentric, less than 1 cm in size, and have a low potential for metastatic spread or development of carcinoid syndrome Small lesions may be successfully treated with endoscopic resection followed by periodic endoscopic surveillance Antrectomy reduces serum gastrin levels and may lead to regression of small tumors Patients with large or multiple carcinoids should undergo surgical tumor resection

Burkitt MD et al Review article: pathogenesis and management of gastric carcinoid tumors Aliment Pharmacol Ther 2006 Nov 1;24(9):1305 20 [PMID: 17059512]

Hwang JH et al American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses Gastroenterology 2006 Jun;130(7):2217 28 [PMID: 16762644] Lograno R et al Recent advances in cell biology, diagnosis, and therapy of gastrointestinal stromal tumor (GIST) Cancer Biol Ther 2004 Mar;3(3):251 8 [PMID: 14726714] Van Glabbeke M et al Initial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma GroupAustralasian Gastrointestinal Trials Group study J Clin Oncol 2005 Aug 20;23(24):5795 804 [PMID: 16110036]

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