Eighteen patients with primary gastric lymphomas and two with pseudolymphomas 
treated at the University of Louisville affiliated hospitals were analyzed in 
order to develop a more precise understanding of these rare diseases. Abdominal 
pain and weight loss were the most common initial symptoms. Only one patient 
presented with an abdominal mass. Upper GI series were helpful but failed to 
show a definite abnormality in two of 18 cases. Endoscopic examinations in all 
18 were compatible with malignancy on gross finding, but six out of 15 
endoscopic biopsies were not conclusive. All four cases, which proved fatal in 
less than two years, showed serosal invasion and diffuse histological pattern. 
On the basis of our analysis, we suggest that in patients with abdominal pain 
and weight loss of more than two months duration an aggressive course of 
evaluation should include upper gastrointestinal x ray and repeated endoscopic 
biopsy. If symptoms persist, laparotomy and biopsy may be warranted even if 
endoscopic biopsy shows no neoplasm. Curative surgery is the treatment of 
choice, but radiation therapy should be added in patients with serosal 
involvement. Very careful histological assessment of pseudolymphomas is 
necessary, because they may contain malignant lymphoma.