Gastric MALT Lymphoma

Question 1

Gastric MALT Lymphoma

Answer 1

Gastric MALT lymphoma

Overview
associated with H. pylori infection in 95% of cases
good prognosis
if low grade then 80% respond to H. pylori eradication

Features
paraproteinaemia may be present

Question 2

Gastric MALT Lymphoma - Example Question

Answer 2

A 49 year-old woman is referred by her GP with a worsening 3-week history of chest pain and burning behind the sternum after eating. Other symptoms include tiredness and the patient has noticed that over the past four months her clothes have started to become much looser on her, although she has put this down to stress at work and skipping meals. She denies night sweats and her only past medical history is mild hypertension for which she takes ramipril. She is on no other regular medication and her father died of lung cancer at the age of 67. Her mother is still alive and well. She drinks 10-15 units per week and has a 25 pack year history.

On examination, heart sounds 1 and 2 are present with no added sounds, her pulse is regular and the character is good and she has clear lung fields. Abdominal exam reveals a soft, non-tender abdomen and bowel sounds are present.

She is referred to gastroenterology where an endoscopy reveals a 2cm diameter area that looks roughened and suspicious. Biopsy of this area is reported as having large number of lymphocytes that have irregular nuclear contours with abundant cytoplasm.

Which of the following is the most appropriate first-line treatment for this condition.

	Endoscopic surgical excision
	Chemotherapy
	Open surgery
	> Amoxicillin, clarithromycin and omeprazole treatment
	Radiotherapy

The condition described here is a MALT lymphoma (or MALToma) which is a form of lymphoma invading the mucosa-associated lymphoid tissue. Because there is a causal relationship between Helicobacter Pylori infection and MALT lymphoma, it is vital to identify the presence of H. pylori and treat it. 50-90% of cases achieve complete response with H. pylori treatment and eradication.

While radiotherapy may be a valid option for MALT lymphoma, the irradiation fields can potentially be very large, as the whole stomach must be included. Chemotherapy is reserved for those patients with disseminated disease or a lack of response to local treatment.

Question 3

Gastric MALT Lymphoma - Example Biopsy Findings

Answer 3

Eg endoscopy reveals a 2cm diameter area that looks roughened and suspicious. Biopsy of this area is reported as having large number of lymphocytes that have irregular nuclear contours with abundant cytoplasm.