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Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study
(2023)
Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11–99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25–59.6%) and ulcer type (15.6–50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.
Bacillus licheniformis is one of the most important hosts used in the biotechnological industry for the production of technical enzymes, antibiotics and a number of biochemicals. Although this bacterium has been used for a long time as an expression host, only little information on expression systems of this host is available. An expression system could be controlled by a cell density signal, a specific chemical inducer or a thermal shift. A limiting substrate such as glucose or phosphate limitation is suggested to use as the signal for the induction of an expression system. When B. licheniformis cells are subjected to nutrient limitation conditions, numerous genes involved in the metabolism of alternative nutrient sources are induced in order to keep cell survival. Therefore, the main topic of this study was to identify and investigate the regulation of genes or operons which are strongly induced in B. licheniformis cells grown under nutrient limitation conditions in order to apply for the construction of potential new expression systems. The research includes studies on the regulation of genes which are responsible for the acetoin and 2,3-butanediol utilization in B. licheniformis cells grown under glucose limitation conditions. Furthermore, we also analyzed the regulation of phytase gene expression as well as investigated the function of a putative ribonuclease expressed in B. licheniformis under phosphate limitation conditions. From this study, it was shown that in B. licheniformis, the utilization of acetoin and 2,3-butanediol was mainly mediated by enzymes encoded by the acoABCL operon. The transcription of this operon was regulated by sigma L transcription factor and was induced by acetoin. The acuABC operon was suggested to play as an indirect regulatory role for the acetoin utilization in B. licheniformis. This operon was controlled by a typical sigma A dependent promoter, however, acetoin was not an inducer for its expression. Furthermore, the regulation of phytase gene expression was suggested to be controlled by PhoPR-two component systems. The results showed that phytate, which is the substrate of phytase enzyme, was not an inducer for the expression of phy gene. However, growth experiments revealed that phytate served as a good alternative phosphate source for the growth of B. licheniformis cells under these conditions. Finally, the inactivation of BLi03719 gene, coding for a putative ribonuclease, resulted in an increase of the total RNA concentration of B. licheniformis cells grown in phosphate limited medium. However, the mutation did not affect the expression of the heterologous reporter gene. Therefore, it could be speculated that the putative ribonuclease BLi03719 plays a role in ribosomal RNA degradation under these conditions.