Primary Gastric Lymphoma: A Silent Assassin

The gastrointestinal (GI) tract is the predominant site of extra nodal lymphoma involvement. Gastric lymphoma is the most common extra nodal site of lymphoma. Most of these lesions are either extra nodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT) type or diffuse large B cell lymphoma (DLBCL). Primary gastric lymphoma accounts for less than 5% of gastric cancers. They are usually non-Hodgkin’s lymphomas (NHL), but have been considered as a separate entity from NHLs of peripheral nodes. The diagnosis of primary lymphoma of stomach requires histological confirmation without any evidence of peripheral lymphadenopathy or organomegaly. Secondary gastric lymphoma indicates the involvement of the stomach by a diffuse lymphoma developed elsewhere. We report a 60 years old male presented with intermittent vomiting and reflux symptoms. Upper GI endoscopy showed large hard mass with superficial ulceration in the fundus of stomach. Histopathology showed lymphoproliferative disorder. Immunohistochemistry confirmed positive CD 20 and BCL 2 suggestive of extranodal marginal zone B cell lymphoma. Subsequently, he was referred to surgery and oncology department for further management.