Korean J Hematol.  2009 Dec;44(4):261-267. 10.5045/kjh.2009.44.4.261.

A Case Report of Helicobacter Pylori Negative Gastric MALT Lymphoma with Monoclonal Gammopathy

• Hwang EK
• Jang EJ
• Kim SM
• Jeong SH
• Lee HW
• Kang SY
• Choi JH
• Han JH
• Kim JH
• Kim MW
• Yoo BM
• Park JS

• KMID: 2252106
• DOI: http://doi.org/10.5045/kjh.2009.44.4.261

Abstract

Lymphomas of mucosa-associated lymphoid tissue (MALT) comprise 7% of all newly diagnosed non-Hodgkin's lymphomas. Helicobacter pylori (H. pylori) negative gastric MALT lymphomas account for 28 to 45% of gastric MALT lymphomas. H. pylori infection has a close relationship with most gastric low-grade B cell lymphomas of the MALT type. Monoclonal gammopathy can be seen in 36% of the patients and negatively associated with responses to eradication of H. pylori in gastric MALT lymphoma. Here, we describe a case of H. pylori negative MALT lymphoma that arose from the stomach with massive plasmacytic differentiation mimicking an extramedullary plasmacytoma with monoclonal gammopathy, and that was cured by total gastrectomy, chemotherapy and radiotherapy.

Keyword

Helicobacter pylori negative; Gastric B cell lymphoma of mucosa-associated lymphoid tissue type; Monoclonal gammopathy

MeSH Terms

Gastrectomy
Helicobacter
Helicobacter pylori
Humans
Lymphoid Tissue
Lymphoma
Lymphoma, B-Cell
Lymphoma, B-Cell, Marginal Zone
Lymphoma, Non-Hodgkin
Paraproteinemias
Plasmacytoma
Stomach

Figure

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  Fig. 1. Results of serum protein electrophoresis showed an abnormal band of protein between β and γ fractions (arrows, panel A & B). The band was identified by immunoelectrophoresis as an IgM lambda light chain component (panel C).

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  Fig. 2. Esophago-Gastro-Duode-noscopic findings revealed multiple shallow ulcerations spread on entire stomach. (A, gastric fundus; B, gastric mid-body).

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  Fig. 3. Endoscopic Ultrasonographic finding showed that the gastric lesions were usually limited only to mucosa and submucosa. However, some focal area (arrows) showed infiltrations reached up to lamina propria.

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  Fig. 4. The pathology of total gastrectomy specimen. (A) Pathologic gross findings of the stomach showed multiple ulcerations (arrows) similar to endoscopic findings. (B) H&E stain (×200) of the stomach shows differentiated or undifferentiated plasma cells packed in mucosa and submucosa layer just like plasmacytoma.

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  Fig. 5. Immunohistochemical stains (×200) in stomach showed that the putative cells expressed CD79a and Ig M, lambda, but did not express CD20. According to strong expression of CD79a, common marker of plasma cells, these findings suggest rather extramedullary plasmacytoma of the stomach than gastric MALT lymphoma.

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  Fig. 6. Results of immunohistochemical stains (×200) in lymph node. Unlike to the stomach, the infiltrated cells expressed CD20 strongly in the lymph node.

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  Fig. 7. Esophago-Gastro-Duode-noscopic findings revealed post total gastrectomy with Billoth I anastomosis status, not remarkable multiple shallow ulcerations spread on entire stomach. (A, gastric fundus; B, gastric mid-body).

Reference

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