MALIGNANT LYMPHOMA OF THE SMALL AND LARGE BOWEL IN IRAQ (MIDDLE EAST LYMPHOMA)

Background and Objectives: Primary gastrointestinal tract (GIT) is the most common site in extra nodal Lymphoma which accounts for 5-10% of all non-Hodgkin’s lymphomas.  The most common organs involved are the stomach, followed by the small intestine and ileocecal region of the colon.  It can also be secondary to wide spread nodal disease with pathological appearance of bulky lymph node.  We report the experience of 227 cases of Small Bowel primary Lymphoma (SBPL) and 18 cases of Colorectal Primary Lymphoma (CRPL) that spans a period from 1965-2000 reported at the Medical City Hospital, Medical School of Baghdad, Iraq operated by one surgeon (ZRB). Patients and Methods: From 1965 to 2000, there were 245 patients collectively with Primary Lymphoma of the Small Intestine and Colorectal area.  There were 227 small bowel lymphoma and 18 colorectal cases that underwent surgery by resection, bypass or exploration.  The most frequent symptoms in (SBPL) were weight loss, abdominal pain, diarrhea, fever, vomiting, melena in addition to abdominal mass, clubbing, ascites, hepatomegaly.  It was complicated by malabsorption syndrome, peritonitis, obstruction, jaundice.  The most frequent symptom of (CRPL) was intestinal obstruction, abdominal mass, dyspepsia, rectal bleed- ing, diarrhea and weight loss.  The most frequent site in (SBPL) was a tumor located in the duodenum in 10 cases, the jejunum in 37 cases, and the ileum in 53 cases with multicentric in 127 cases.  While the location in the (CRPL) were the cecum 6, ascending colon 7, transverse colon 1, sigmoid colon 2 and rectum 2.  Histologically, there were 178 high-grade and 49 low-grade non-Hodgkin’s lymphoma and in the (CRPL), 8 were high-grade, 9 low-grade non-Hodgkin’s lymphoma and one Burkitt’s lymphoma.  The most common pathological type in small bowel lymphoma is Lymphoplasmacytic while in the large bowel was intermediate and high grade large B cell lymphoma. Results: Radical surgery was performed on 201 patients of all stages in (SBPL) with 179 patients having  post-operative chemotherapy, 8 had radiation treatment with 14 having the combination of chemotherapy/radiation therapy.  Survival rate for (SBPL) was 92 cases (42%) for 2 years, 55 cases (28%) for 5 years.  The (CRPL) revealed 14 cases (52%) survival of 2-4 years and 12 cases (48%) survived an average of 10 years. Conclusion: Intestinal Lymphoma differs significantly from the gastric lymphoma.  The most common pathological type in the small bowel was lymphoplasmacystic type and in the large bowel was the diffuse intermediate and high grade, Large-B Cell lymphoma. Our experience shows improvement in the prognosis with the combination of treatments in the early localized lesion.  It supports the efficacy of surgery combined with chemotherapy/radiation in obtaining a good remission