Synchronous gastric adenocarcinoma and primary gastric mucosaassociated lymphoid tissue malt lymphoma are rare, and the characteristics of these tumors are still unclear. Mucosaassociated lymphoid tissue malt lymphomas are the extranodal subset of marginal zone bcell lymphomas, representing less than 8% of all types of lymphomas and 5% of newly diagnosed nonhodgkins lymphoma. Gastrointestinal lymphoma is an uncommon disease but is the most frequently occurring extranodal lymphoma and is almost exclusively of nonhodgkin type. Gastric mucosaassociated lymphoid tissue lymphoma and. Pathology outlines extranodal marginal zone lymphoma of. The coexistance of malt lymphoma and diffuse large bcell lymphoma should not be reported as high grade malt because extranodal marginal zone malt lymphoma is an indolent lymphoma. Mucosa associated lymphoid tissue malt lymphoma, also called extranodal marginal zone bcell lymphoma, is a type of lowgrade extranodal lymphoma chronic infectioninflammation has been implicated in the pathogenesis, for example helicobacter pylori. Gastric lymphoma, like carcinoma, most often involves the antrum but may occur in any part of the stomach. The conventional endoscopic findings of gastric malt lymphoma vary widely, ranging from ulcerative or gastritislike lesions to those resembling depressed early gastric cancer, or elevated lesions figure 1.
Malt lymphoma affects the lymphatic system, which is responsible for the immunity, making it weak and prone to infections. It is a slowgrowing bcell nonhodgkins lymphoma affecting adults. Persistence of this condition for a long time can lead to malt lymphoma. Extragastric lymphomas are reported to be more aggressive. Our aim was to investigate the particular metabolic behavior of these lymphoma. Malt lymphoma of the stomach mls has only recently been included in a lymphoma classification. Malt lymphoma is called extranodal because it starts in tissues or organs outside of the lymph nodes. Marginal zone lymphoma, abbreviated mzl, is a common type of lymphoma composed of small cells. Morphological features of malt lymphoma of the stomach before and after eradication therapy. Presented in part at the tutorial on pathology of the gi tract, pancreas, and liver. Treatment should be tailored to the affected organ and may consist of surgery, chemotherapy andor radiation therapy 2. The main treatment of malt lymphoma include radiotherapy, chemotherapy, surgery or.
Given that there is normally no lymphoid tissue in gastric mucosa and. Extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue malt is a bcell nonhodgkin lymphoma nhl. Other sites that may be involved include the salivary glands, eyes, lung, i. Malt lymphoma can also develop in salivary glands due to autoimmune condition. Under microscopic examination, the biopsy tissue usually shows dense lymphoid infiltration. Mucosaassociated lymphoid tissue lymphoma malt lymphoma accounts for approximately 5% of nonhodgkin lymphomas, and the gastrointestinal gi tract is the most common site of involvement. Primary gastric lymphoma nord national organization for. Antibiotics are used to treat gastric malt lymphoma.
The histological features of gastric lymphoma arising. The pathological diagnosis of gastric malt lymphoma can be reached by. In the literature the detection rate of 18ffdgpetct in patients with gastric malt lymphoma is variable, and the reason for this heterogeneity is not still clear. Gastric mucosa associated lymphoid tissue malt lymphoma is a low grade b cell lymphoma histologically characterised by neoplastic b cells surrounding follicles in a marginal zone pattern and selectively infiltrating epithelium to form characteristic lymphoepithelial lesions. Primary lymphoma of the gall bladder, most commonly a malt lymphoma or dlbl, is very rare and typically present as right upper quadrant pain. Gastric lymphoma malt mucosa associated lymphoid tissue is when a. In the stomach, multifocal microscopic deposits of lymphoma throughout the gastric mucosa is well documented. Malt lymphomas hematology american society of hematology. Their histology suggests that immunological mechanisms might be operative in their growth.
Primary gi nonhodgkin, lymphoma in a populationbased registry. Gastric mucosa associated lymphoid tissue lymphoma malt is a rare disease, 1 described for the first time in 1983 by isaacson and wright 2. Primary gastric lymphoma pathogenesis and treatment. Gastric mucosaassociated tissue lymphoma malt lymphoma is a rare mature bcell neoplasm associated with h. The paths of h pylori and gastric malt lymphoma research crossed for the first time in 1988 with the recognition that the cause of acquired gastric malt is chronic infection with h pylori. Helicobacter pylori gastritis typical histopathology is characterized by. Gastric malt mucosaassociated lymphoid tissue lymphoma is a marginal zone lymphoma mzl of the stomach. The incidence of lymphoma has been on the rise over the past 2 to 3 decades. We describe nine cases of gastric adenocarcinoma six intestinal and three diffuse type occurring in the stomach synchronously with primary low grade b.
Other studies also reported that gastric malt lymphoma patients with t11. The role of 18ffdgpetct in evaluating gastric malt lymphoma is still controversial. Alcohol use disorders identification testconcise auditc brief screen to detecting heavy alcohol use alcohol use disorders identification test audit screen for active alcohol abuse or dependence cage questionnaire 4 question screening for alcohol problems car, relax, alone, forget, friends, trouble crafft 2. Because this translocation is more frequently observed in h pylorinegative gastric malt lymphoma patients12,14, this needs to be taken into consideration. Malt lymphoma is considered an indolent disease with a good prognosis. Primary gastrointestinal lymphoma most commonly involves the stomach but can involve any part of the gastrointestinal tract from the esophagus to the rectum. Histological grading in gastric lymphoma gastroenterology. The recurrence rate of malt lymphoma of salivary glands is higher than that of malt lymphoma of the thyroid and stomach. According to worldwide literature, nhl accounts for 23% of all malignancies in the world and malt lymphomas comprise approximately 5% of all nhls. In establishing a diagnosis of gastric marginal zone lymphoma of malt type. Primary gastric lymphoma is a general term for a type of cancer that originates within the stomach. May have coexisting gi or gu carcinomas am j surg pathol 1997. Sixtynine patients 26 female, 43 male with histologically.
Synchronous adenocarcinoma and mucosaassociated lymphoid. Malt lymphoma treatment algorithm bmj best practice. The topic malt lymphoma of stomach you are seeking is a synonym, or alternative name, or is closely related to the medical condition gastric malt lymphoma. Aproximadamente summary the stomach is the most frequent site of extranodal lymphoma. Extranodal marginal zone lymphoma, also called low grade bcell lymphoma of mucosaassociated lymphoid tissue malt, is an extranodal lymphoma that arises in a number of epithelial tissues. If this infection is not treated, it can produce chronic inflammation in the stomach mucosa. This increase has been observed in extranodal forms. It is a cancer originating from b cells in the marginal zone of the malt, and is also called extranodal marginal zone b cell lymphoma.
The lymphoma is derived from marginal zone bcells and recapitulates the architecture and organisation of native malt exempli. The maltomas arise in the context chronic infective or inflammatory conditions, e. Marginal zone lymphomas are typically not very aggressive and have better prognosis compared to other bcell lymphomas. To identify solitary epithelial cells in gastric malt lymphoma and investigate their nature.
Bhs guidelines for the treatment of marginal zone lymphomas. Extranodal marginal zone lymphoma of mucosaassociated. The aim of this study was to elucidate the histopathological behavior of pgl according to the concept of malt and to compare the predictive value of tests frequently used for diagnosis of h. The stomach is the most common site of localization, accounting for about onethird of cases. During recent years there have been relevant changes in the. It develops in lymphatic tissue in the mucous membranes or tissues that line body organs or cavities. Most gastric malt lymphomas arise in patients in whom gastroscopy showed. Malt and histiocytic lymphoma of stomach am j surg pathol 1996.
The histopathological examination for diagnosis of malt. Diagnosis the most common presenting symptoms of gastric malt lymphoma are nonspecific upper gastrointestinal gi complaints that often lead to an endoscopy. Median age is 60 years old with a male predominance. In four cases the two neoplasms were admixed to form collision tumours. Malt lymphomas are generally low grade and follow an indolent course. The stomach and small intestine are the most common sites of involvement in the gi tract.
Accounting for about 9% of all b cell lymphoma most commonly encountered in gi tract with stomach the most frequently involved. Extranodal marginal zone b cell lymphoma of malt type malt lymphoma is one of the lymphoma subtypes that has allowed us some of the most interesting. Malt lymphoma maltoma is a form of lymphoma involving the mucosaassociated lymphoid tissue malt, frequently of the stomach, but virtually any mucosal site can be afflicted. Ninety per cent of primary gastric malt lymphomas gml are associated. Primary malignant lymphoma of the stomach are almost all non hodgkins type and of bcell lineage. The diagnosis of gastric malt lymphoma is frequently difficult for the general histopathologist. The pathological diagnosis of gastric malt lymphoma can be reached by histological. Where collision was present between lymphoma and adenocarcinoma of intestinal type no lymphoepithelial lesions were seen involving neoplastic glands. Chronic active antral gastritis, with or without chronic active superficial gastritis in the corpus lymphoplasmacytic inflammation in the lamina propria neutrophils in the lamina propria and gastric pits lymphoid aggregates and follicles characteristic bacilli, primarily in the foveolar mucus. The risk for recurrence of head and neck malt lymphomas is further enhanced when only local therapies are applied. The 10year recurrencefree rate of malt lymphoma of salivary glands is 68%, whereas the 10year recurrencefree rate of malt lymphoma of the thyroid and stomach was reported to be 95% and 92%, respectively. Lymphoproliferative disorders of the gastrointestinal.
Helicobacter pylorinegative gastric mucosaassociated. Most cases are middle aged and elderly, usually over 50 years. These lymphomas usually arise from malt mucosa associated lymphoid tissue also known as marginal zone b cell lymphoma low and high grade. Gela histological scoring system for posttreatment. The histological features of gastric malt lymphoma, which by definition is a low grade lymphoma, closely simulate those of the peyers patch. Malt lymphomas comprise approximately 5% of all nonhodgkins lymphomas in the united states. Approximately 90 percent of patients of primary gastric lymphoma are either mucosaassociated lymphoid tissue malt gastric lymphoma or diffuse large bcell lymphoma dlbcl of the stomach. Malt lymphoma affects various organs, with the stomach being. Colonic malt lymphoma is a rare condition that comprises only 2. Lymphoproliferative disorders of the gastrointestinal tract. The classical lymphoma classification systems rappaport, kiel, and lukescollins, as well as the working formulation, largely ignored the extranodal lymphomas and did not recognize the unique entity of malt lymphoma 54. Histopathology of lymph node and bone marrow spread.
A 34yearold female with extranodal marginal zone lymphoma. Solitary epithelial cells in b cell gastric malt lymphoma. The malt lymphoma concept updated annals of oncology. Plasmablastic lymphoma pbl is a unique lymphoma, first described by delecluse and associates as a rare variant of diffuse large bcell lymphoma dlbcl involving the oral cavity. Malt lymphomas is a multidisciplinary book that covers all the aspects of malt lymphomas, from the molecular biology, the aetiology and the pathology, to all the possible therapeutic approaches. In mucosal biopsies, gastric malt lymphoma is characterised by a monotonous infiltrate of monocytoid bcells that expand and replace the normal. Primary gastric lymphoma pgl represents a rare pathology, which can be easily misdiagnosed because of unspecific symptoms of the digestive tract. The main causes of malt lymphoma is chronic infections and persistent inflammation in the body. Primary gastric lymphoma, epidemiology, clinical diagnosis. The stomach is the most frequently involved organ, and in most cases detected in 90%, there is a strong association between gastric malt lymphoma and chronic infection. Hematoxylin and eosin staining show the histopathologic features of rectal mucosa. Extranodal marginal zone lymphoma of malt lymphoma is the 4th commonest b cell non hodgkins lymphomanhl worldwide. The histopathology and immunohistology of gastric malt lymphoma.
Sjogren disease salivary gland, hashimoto thyroiditis thyroid gland, helicobacter pylori gastritis stomach. Primary gastric marginal zone lymphoma of mucosaassociated lymphoid tissue malt is a lowgrade bcell malignancy with an indolent clinical course. Symptoms include loss of appetite, weight loss, indigestion, tiredness etc. Extranodal marginal zone lymphoma of mucosaassociated lymphoid tissue malt lymphoma is a mature bcell neoplasm that occurs in a variety of extranodal tissues, including the gastrointestinal tract, lung, oropharynx, salivary gland, ocular adnexa, and skin, often arising in the setting of chronic inflammation or autoimmune disease. Cureus mucosaassociated lymphoid tissue lymphoma of. Prospective study of helicobacter pylori eradication therapy in. In some cases, more than one gross pathologic type of gastric malt lymphoma coexists in the same stomach.