Gastric malignancy: clinicopathologic spectrum and relationship to Helicobacter pylori infection.

Background: Upper gastrointestinal cancer particularly of stomach is a relatively frequent form of cancer. Gastric H pylori infection has been implicated in the pathogenesis of both gastric carcinoma and gastric lymphoma. Gastric carcinoma has been addressed by many articles in the Kingdom of Saudi Arabia (KSA) and the Middle East, while only a few addressed gastric lymphoma.

Aim Of The Study: To investigate the relative frequency of gastric carcinoma and gastric lymphoma and their association with H pylori infection in endoscoped patients.

Patients And Methods: A retrospective study of patients endoscoped at King Fahad Hospital of the University, Al-Khobar, KSA during the period 1983-1999 was performed. Endoscopy and pathology records were retrieved and reviewed. The histopathology slides were re-examined, applying immunohistochemical techniques on corresponding paraffin sections to classify the various tumors. H pylori were identified on routine histology and by utilizing Giemsa stain.

Results: During the study period of 17 years (1983-1999), a total of 94 endoscopically-diagnosed, histologically-confirmed cases of gastric malignancy were identified. Of these, there were 55 gastric adenocarcinoma and 39 gastric lymphoma. H pylori was identified in the adjacent gastric mucosa in 18 of all cases of gastric adenocarcinoma and in 27 of the 39 cases of lymphoma.

Conclusion: The study demonstrates the comparatively high frequency of gastric lymphoma in this population and confirms the intimate association of H-pylori infection to both gastric adenocarcinoma and MALT-lymphoma. Gastric lymphoma should always be considered in the differential diagnosis of gastric malignancy and the use of immunohistochemistry is essential for the differential diagnosis of some of these tumors.