Background: Gastric lymphomas are heterogeneous disease in terms location, endoscopic patterns, histological subtypes, and treatments offered. We present a retrospective study of clinicopathological profile of primary gastric lymphoma from a single tertiary care center in northern India. The study was done with an aim to evaluate the histological features, patterns of endoscopic findings and role of bone marrow involvement in PGL. 

Methods: Consecutive cases of all PGLs within a 14-year period were retrieved. Histological and immunohistochemical features of all cases were evaluated and endoscopic biopsies were compared with resection specimens. 

Results: Diffuse large B-cell lymphoma was the commonest PGL subtype accounting for 62.5%. Marrow involvement by lymphoma was not observed in any of the cases. A high diagnostic discordance was observed when biopsy findings were compared with resection specimens. The sensitivity of and specificity of endoscopic biopsy was 92% and 88% respectively for diagnosing lymphoma. Additional histological features (carcinoid, amyloidosis and granuloma) were observed in few cases. 

Conclusion: We demonstrated the various endoscopic patterns of gastric involvement in PGL. A high false negative rate for diagnosis of PGL in endoscopic biopsies alone was observed. BM examination as part of initial diagnostic work-up in PGL could be avoided due to rarity of marrow involvement by the disease.