Clin Endosc.  2013 Nov;46(6):647-650.

A Polypoid Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach Treated with Endoscopic Polypectomy

• Min SY
• Lee JH
• Rhee PL

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is the most common extranodal lymphoma of the gastrointestinal tract. It is usually accompanied by Helicobacter pylori infection, and eradication of H. pylori remains the mainstay of treatment for gastric MALT lymphoma. However, there is no consensus on the second-line treatment for patients with gastric MALT lymphoma who do not improve after successful H. pylori eradication. Here, we report the case of a 34-year-old woman who presented with a polypoid type of gastric MALT lymphoma on the greater curvature side of the upper body. Despite successful H. pylori eradication, the tumor did not regress after 6 months. Because the tumor had a semipedunculated polypoid morphology, gastric polypectomy was implemented as a second-line treatment. No recurrence occurred during the 3-year follow-up period. We suggest that gastric polypectomy be considered an alternative treatment modality for polypoid gastric MALT lymphoma that is unresponsive to H. pylori eradication.

Keyword

Gastric mucosa-associated lymphoid tissue lymphoma; Polypectomy; Helicobacter

MeSH Terms

Adult
Consensus
Female
Follow-Up Studies
Gastrointestinal Tract
Helicobacter
Helicobacter pylori
Humans
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell, Marginal Zone*
Recurrence
Stomach*

Figure

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  Fig. 1 Upper gastrointestinal endoscopic findings. The endoscopic image shows a 2-cm polypoid lesion on the greater curvature side of the high body of the stomach.

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  Fig. 2 Abdominal computed tomography (CT) findings. The CT scan shows a 1.8-cm polypoid lesion with minimal stalk in the stomach.

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  Fig. 3 (A-F) Gastric polypectomy. Hypertonic saline was injected into the submucosal layer and a snare resection was performed en bloc. The exposed vessels on the base of the artificial ulcer were coagulated with hot biopsy. Thereafter, three hemoclips were attached. No complications occurred.

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  Fig. 4 Microscopic findings (H&E stain). (A) This specimen shows formation of a reactive lymphoid follicle. Atypical lymphocytes grow out of the germinal center and mantle layer (×100). (B) The atypical lymphocytes infiltrate the mucosal layer with the destruction of glandular structures. This feature is called a lymphoepithelial lesion (×200).

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  Fig. 5 Follow-up upper gastrointestinal endoscopic findings. A whitish linear scar is seen on the previous polypectomy site. No recurrence is evident.

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