Gastric MALT Lymphoma: a Rare Manifestation of a Common Disease

Excerpt

A 61-year-old woman presented with a 2-month history of intermittent upper abdominal pain and progressive weight loss. There were no constitutional symptoms with no overt blood loss. Her medical history was hysterectomy due to hysteromyoma. She was taking no medications. On physical examination, her abdominal examinations were unremarkable. Laboratory tests were normal. White light gastroscopy showed mucosal swelling with appearance of the cerebral sulci and gyri in the greater curvature of the upper part of the stomach (Fig. 1A). Endoscopic view of the lesion in narrow band imaging revealed irregular surface pattern with the increased microvessel intensity and homogeneous vascular thickness (Fig. 1B). Histopathological examination confirmed morphological and immunophenotypic characteristics of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) (Fig. 1C, D, E). Urease test was positive for Helicobacter pylori. MALT lymphoma may involve the gastrointestinal (GI) tract, respiratory tract, conjunctiva and salivary glands [1]. Involvement of the stomach by GI MALT lymphoma is common in comparison with other sites [2]. The surface characteristics of gastric MALT lymphoma is variable, ranging from ulcerative or erosive lesions to hypertrophic or depressed lesions. However, swollen lesions with appearance of the cerebral sulci and gyri are rare in upper GI MALT lymphoma. Clinicopathological correlation is crucial for the diagnosis. In small biopsy specimens, it is challenging to differentiate MALT lymphoma from florid reactive lymphoid tissue histologically due to its deficiency of pathognomonic characteristics. Treatment of gastric MALT lymphoma depends on disease stage, which usually has an excellent prognosis. Our patient was treated with rituximab monotherapy and responded well due to the failure of Helicobacter pylori eradication and the persistence of lesions in the stomach. Repeat upper gastrointestinal endoscopy confirmed complete resolution of the lesion.

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