Korean J Gastroenterol.  2011 May;57(5):272-280. 10.4166/kjg.2011.57.5.272.

Diagnosis and Treatment of Gastric MALT Lymphoma

• Choi MK
• Kim GH

• KMID: 1792783
• DOI: http://doi.org/10.4166/kjg.2011.57.5.272

Abstract

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma represents approximately 40% of gastric lymphomas, and its incidence is increasing. An early diagnosis for gastric MALT lymphoma is important, but not easy due to non-specific symptoms and endoscopic findings. Diagnosis is based on the histopathologic evaluation of multiple, deep and repeated biopsies taken from normal and any abnormal appearing sites of the stomach. In addition, the presence of Helicobacter pylori (H. pylori) infection must be determined to determine therapeutic approach. Endoscopic ultrasonography (EUS) is essential for the evaluation of regional lymph nodes and the depth of tumor invasion in the gastric wall, for predicting response to H. pylori eradication, and for monitoring tumor regression or recurrence. The eradication of H. pylori is recommended as an initial treatment for low-grade gastric MALT lymphoma with H. pylori infection. Both radiation therapy and chemotherapy are suitable alternative options for H. pylori-negative, refractory, or high-grade gastric MALT lymphoma. But, the role of surgery is diminishing. After treatment, strict endoscopic regular follow-up including EUS is recommended with multiple biopsies. However, controversy remains regarding the best diagnosis, treatment and follow-up strategy for this disease.

Keyword

Gastric MALT lymphoma; Diagnosis; Treatment

MeSH Terms

Biopsy, Fine-Needle
Endosonography
Gastroscopy
Helicobacter Infections/complications/drug therapy
Humans
Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/therapy
Stomach Neoplasms/complications/*diagnosis/therapy

Figure

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  Fig. 1. Endoscopic findings of superficial type gastric MALT lymphoma. (A) IIc-like type. (B) Submucosal tumor type. (C) Multiple erosion type.(D) Cobblestone-mucosa type. (E) Partial-fold-thickening type. (F) Discoloration type.

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  Fig. 2. Histological features of gastric MALT lymphoma. Neoplastic lymphoid cells invaded gastric glands (lymphoepithelial lesion, arrow).

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  Fig. 3. Algorithm suggested for the diagnostic procedure of gastric biopsies.15*Lymphoma of MALT type.

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  Fig. 4. EUS findings of gastric MALT lymphoma. (A) Tumor limited to the mucosa (T1). (B) Tumor limited to the submucosa (T2). (C) Tumor extended to the serosa (T3).

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  Fig. 5. Pre- and post-treatment endoscopic findings of gastric MALT lymphoma after H. pylori eradication. (A-C) Pre-treatment endoscopic findings. (D-F) Post-treatment endoscopic findings. Whitish discolored areas appeared at the site where the previous MALT lymphoma disappeared after H. pylori eradication.

Reference

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