Clinicopathological comparison of the World Health Organization/Wotherspoon score to the Groupe d'Etude des Lymphomes de l'Adult grade for the post-treatment evaluation of gastric mucosa-associated lymphoid tissue lymphoma

• Published in: Journal of gastroenterology and hepatology Vol. 24; no. 2; pp. 307 - 315
• Main Authors: Shiozawa, Eisuke, Norose, Tomoko, Kaneko, Kazuhiro, Yamochi-Onizuka, Toshiko, Takimoto, Masafumi, Imawari, Michio, Ota, Hidekazu
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.02.2009; Wiley-Blackwell
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Biological and medical sciences; Coloring Agents; Eosine Yellowish-(YS); Female; Gastric Mucosa - microbiology; Gastric Mucosa - pathology; gastric mucosa-associated lymphoid tissue lymphoma; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter pylori - drug effects; Hematologic and hematopoietic diseases; Hematoxylin; histological criteria; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, B-Cell, Marginal Zone - microbiology; Lymphoma, B-Cell, Marginal Zone - pathology; Lymphoma, B-Cell, Marginal Zone - therapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; post-treatment evaluation; Predictive Value of Tests; Proton Pump Inhibitors - therapeutic use; Radiotherapy, Adjuvant; Staining and Labeling - methods; Stromal Cells - pathology; stromal change; Time Factors; Treatment Outcome; World Health Organization; World; Human; stromal change; Stomach; Malignant hemopathy; Non Hodgkin lymphoma; MALT lymphoma; Treatment; post-treatment evaluation; Lymphoproliferative syndrome; Gastroenterology; histological criteria; Adult; Comparative study; gastric mucosa-associated lymphoid tissue lymphoma; Cancer
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2008.05639.x

Background and Aim:  The World Health Organization (WHO) has adopted criteria for the histological differential diagnosis of gastric extranodal marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue (GML) based on the criteria proposed by Wotherspoon in 1993 (WHO/Wotherspoon score). These histological criteria are commonly used by pathologists for initial diagnoses, but have not been adopted uniformly for the post‐treatment evaluation of GML. In 2003, the Groupe d’Etude des Lymphomes de l’Adult (GELA) proposed a new histological grading system (GELA grade) in preference to use of the WHO/Wotherspoon score for post‐treatment evaluation. In the present study, we compared the WHO/Wotherspoon and GELA systems to examine which histological criterion is better for post‐treatment evaluation. Methods:  Fourteen cases of GML under long‐term follow up were initially diagnosed according to the WHO criteria with detailed immunohistology, and were periodically evaluated with both histological criteria after anti‐Helicobacter pylori treatment. They were also evaluated based on histological stromal changes accompanying the disappearance of lymphoma tissue. Results:  The study showed strong similarities between the WHO/Wotherspoon and GELA systems and no clear advantage of either system for post‐treatment evaluation. The GELA grade could not be used for the evaluation of changes in the degree of lymphoma infiltration from pre‐ to post‐treatment because the four‐item scale is not comparable with the formal six‐point WHO/Wotherspoon scale. Stromal changes in the lamina propria, including an empty appearance and fibrosis, were correlated with lymphoma reduction after treatment and appear to be good indicators for post‐treatment evaluation. Conclusion:  We propose the utilization of the WHO/Wotherspoon score accompanied by the assessment of stromal changes for the post‐treatment evaluation of GML.