What are the symptoms of gastric lymphoma?

Symptoms of Gastric Lymphoma

The most common presenting symptoms of gastric lymphoma include non-specific upper gastrointestinal complaints such as abdominal pain, weight loss, dyspepsia, vomiting, early satiety, and/or iron-deficiency anemia. 1

Common Clinical Presentations

Gastrointestinal Symptoms

• Abdominal pain (occurs in up to 76.5% of patients) 2
• Dyspepsia (non-specific upper GI discomfort) 1
• Nausea and vomiting 2, 3
• Early satiety 1
• Abdominal distension 2
• Dysphagia (less common) 1, 2

Systemic Symptoms

• Weight loss (occurs in approximately 33.3% of patients) 2, 3
• Iron-deficiency anemia (occurs in about 54.3% of patients) 1, 2
• Fever (less common, approximately 8.6% of cases) 2

Concerning Symptoms

• Gastrointestinal bleeding (occurs in up to 55.6% of patients) 2
• Palpable abdominal mass (found in approximately 25.9% of cases) 2, 3
• Bowel obstruction (occurs in about 11.1% of patients) 2
• Digestive tract perforation (rare, approximately 1.2% of cases) 2

Symptom Patterns by Lymphoma Type

MALT Lymphoma

MALT lymphoma represents about 7% of all non-Hodgkin lymphomas, with at least one-third presenting as primary gastric lymphoma 1. The symptoms are typically:

• More indolent and non-specific
• Often mimic gastritis or peptic ulcer disease
• Frequently associated with H. pylori infection 4
• Mass lesions are unusual 1

Diffuse Large B-Cell Lymphoma

• More aggressive presentation
• More likely to present with B symptoms (fever, night sweats, weight loss)
• May arise from transformation of MALT lymphoma 1

Endoscopic Findings

Gastric lymphoma may present with various endoscopic appearances:

• Tumor type (67.7% of cases) 2
• Ulcer type (27.7% of cases) 2
• Diffuse type (4.6% of cases) 2

It's important to note that these endoscopic findings are often non-specific and can mimic other conditions such as gastritis, peptic ulcer disease, or gastric adenocarcinoma 5.

Diagnostic Challenges

The symptoms of gastric lymphoma are often non-specific, leading to:

• High rates of misdiagnosis initially 5, 2
• Delayed diagnosis (clinical diagnosis rate is only about 30.9%) 2
• Need for multiple biopsies or repeated endoscopic evaluations 2

Risk Factors to Consider

When evaluating patients with these symptoms, consider risk factors for gastric lymphoma:

• H. pylori infection (particularly for MALT lymphoma) 4
• Chronic inflammatory conditions of the stomach 5
• Autoimmune disorders 5
• Immunosuppression 5

Clinical Pearls

1. The non-specific nature of symptoms often leads to delayed diagnosis
2. Endoscopy with multiple biopsies is essential for diagnosis
3. Iron-deficiency anemia without obvious cause should raise suspicion
4. Weight loss combined with upper GI symptoms warrants thorough investigation
5. Symptoms may mimic more common conditions like peptic ulcer disease or gastritis

Early recognition of these symptoms and prompt endoscopic evaluation with multiple biopsies can lead to earlier diagnosis and improved outcomes for patients with gastric lymphoma.