What is the most common presentation of gastric lymphoma?

Most Common Presentation of Gastric Lymphoma

The most common presentation of gastric lymphoma is abdominal pain, which often manifests as non-specific upper gastrointestinal complaints. 1, 2

Clinical Presentations of Gastric Lymphoma

Gastric lymphoma typically presents with:

• Abdominal pain (most common) 3, 4
• Weight loss 3
• Non-specific upper gastrointestinal complaints 1
• Nausea and vomiting 3
• GI bleeding (less common) 5
• Dyspepsia or bloating 5
• Anorexia/loss of appetite 4

Presentation Pattern by Frequency

According to multiple studies, abdominal pain is consistently reported as the predominant presenting symptom in patients with gastric lymphoma. This is followed by weight loss, while systemic symptoms like fever are less frequent 3, 4.

Diagnostic Approach

The non-specific nature of these symptoms often leads to endoscopy, which typically reveals:

• Non-specific gastritis 1
• Peptic ulcer 1
• Mass lesions (unusual) 1

Key Diagnostic Steps

1. Gastroduodenal endoscopy with multiple biopsies from each region of the stomach 1, 2
2. Histopathologic evaluation (gold standard for diagnosis) 2
3. Testing for H. pylori infection (essential for determining treatment approach) 1, 2
4. Endoscopic ultrasound to evaluate regional lymph nodes and gastric wall infiltration 1

Clinical Pitfalls to Avoid

• Misdiagnosis as carcinoma - Endoscopic biopsies may be misinterpreted as carcinoma due to similar appearance 6
• Inadequate biopsy sampling - Multiple biopsies are essential for accurate diagnosis 2
• Failure to test for H. pylori infection - Critical for treatment planning 2
• Premature escalation of therapy - Complete regression may take up to 12-18 months 2

Epidemiology and Pathology

• MALT lymphoma represents approximately 7% of all non-Hodgkin lymphomas 1, 2
• At least one-third of MALT lymphomas present as primary gastric lymphoma 1, 2
• B-cell lymphomas (particularly DLBCL and MALT) are the predominant pathological types 4
• The GI tract is the most commonly involved site for extranodal lymphoma, with the stomach being the most frequently affected organ 5

Understanding that abdominal pain is the most common presenting symptom of gastric lymphoma is crucial for early recognition and appropriate diagnostic workup, which can significantly impact patient outcomes.