Associations between endoscopic findings and clinicopathological characteristics in primary gastrointestinal lymphoma: a single-center retrospective study

Background Primary gastrointestinal lymphoma (PGIL) exhibits pronounced heterogeneity in its clinical and endoscopic manifestations; however, the potential associations between its macroscopic endoscopic morphology and clinicopathological characteristics remain poorly defined.Objective To investigate the correlations between distinct PGIL endoscopic phenotypes and clinicopathological features, tumor burden, and systemic inflammatory status.Methods We retrospectively reviewed 117 patients diagnosed with PGIL (between January 2019 and August 2025). Based on the predominant endoscopic presentations, 105 patients were stratified into ulcerative (n = 43), exophytic (n = 36), and diffuse infiltrative (n = 26) cohorts.Results The ulcerative and exophytic cohorts tended to exhibit potentially elevated systemic tumor burden markers and immune-inflammatory indices. Aggressive diffuse large B-cell lymphoma (DLBCL) predominated in the ulcerative (62.8%) and exophytic (66.7%) groups, whereas the diffuse infiltrative type was primarily characterized by indolent mucosa-associated lymphoid tissue (MALT) lymphoma (88.5%). Radiologically, transmural wall thickening frequently accompanied the ulcerative type (78.0%), while peritumoral fat stranding (50.0%) and abdominopelvic effusion were prevalent in the exophytic type. Furthermore, exploratory regression suggested potential trends linking ulcerative and exophytic phenotypes to aggressive DLBCL, albeit with extremely wide confidence intervals. Therapeutically, the ulcerative type predominantly received systemic chemotherapy (48.8%), the exophytic cohort exhibited the highest rate of surgery combined with chemotherapy (27.8%), and the diffuse infiltrative type was managed conservatively, notably via anti-Helicobacter pylori eradication.Conclusion Distinct PGIL endoscopic phenotypes may indicate variations in histopathology, infiltration, and systemic inflammation. Integrating macroscopic, serological, and radiological features aids in the preliminary tumor assessment; however, these associations remain strictly exploratory and require validation in larger cohorts.