Roentgen Manifestations of Lymphosarcoma of the Stomach

Lymphosarcoma as a generalized process is well known. Focal lymphosarcoma is less familiar, but is being found increasingly. Ackerman and del Regato (1), in their textbook on cancer, write: “Lymphosarcoma is often seen first as a generalized process, but a certain unknown but increasing proportion of cases has been reported with a definite focus of origin. Regato in 1939 reported that lymphosarcoma frequently arose from the region of Waldeyer's ring (nasopharynx, tonsil, base of the tongue). The second-most common location is from the gastro-intestinal tract, from the stomach, large bowel or small bowel.” Sugarbaker and Craver (8), reviewing 196 proved cases of lymphosarcoma, found that 5.5 per cent arose in the digestive tract, and that over half of these had their origin in the stomach. In their series one-third of the cases appeared to originate outside the lymphatic system. Telepaque is supplied in 0.5-gram tablets which are about the size of aspirin tablets and easily swallowed. Experimental studies in animals have demonstrated a wide margin of safety in the doses used to opacify the gallbladder (1). Incidence The latest comprehensive review of lymphosarcoma of the stomach is that of Archer and Cooper (2) in 1939. They stated that up to 1937 Taylor had collected 152 cases of primary lymphosarcoma of the stomach. As a result of a questionnaire to radiologists and institutions, they added to these 94 cases including 3 of their own. Since that time there have been a few sporadic reports of primary lymphosarcoma of the stomach, so that the cases in the literature now probably number about 250. It is our opinion that the incidence of this disease is higher than has previously been thought. Of 250 patients admitted to the surgical service of the Mt. Sinai Hospital (New York) from 1937 to 1943 in whom the diagnosis of neoplasm of the stomach was made, 8 were found to have lymphosarcoma, an incidence of 3.2 per cent (10). Seven of these were small round-cell lymphosarcomas and one was a reticulum-cell sarcoma. This low incidence of reticulum-cell sarcoma of the stomach is borne out by others. Cash and Rappoport (5) mention its rarity and report one case. Roentgen Manifestations There is some disagreement as to the roentgen manifestations of lymphosarcoma of the stomach. Yarnis and Colp (10) felt that gastric lymphosarcoma occurs in two forms, grossly: in one the cells infiltrate diffusely, causing apparent simple hypertrophy of the rugae, while in the other there is definite tumor formation, often with ulceration. The first form is frequently overlooked surgically, since the stomach not only appears normal externally but is quite normal to palpation. The second type is quite indistinguishable grossly from carcinoma. These writers are not sure that giant rugae play an important part in the roentgen diagnosis of lymphosarcoma of the stomach.