Clin Endosc.  2022 Jan;55(1):136-140. 10.5946/ce.2020.232.

Successful Endoscopic Resection of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication Therapy

• Choi J

• KMID: 2525060
• DOI: http://doi.org/10.5946/ce.2020.232

Abstract

Eradication of Helicobacter pylori is the first-line treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphomas; however, lesions may persist in 20% of patients after initial treatment, thereby necessitating the use of an additional therapeutic approach. Other treatment options include radiation therapy, chemotherapy, endoscopic resection, rituximab therapy, or watchful waiting. We present a case of localized gastric MALT lymphoma that did not respond to H. pylori eradication therapy. The patient waited for 12 months but the tumor showed no signs of regression endoscopically. Histologic examination revealed residual MALT lymphoma. The tumor was then successfully treated using endoscopic submucosal dissection and the patient remained disease-free for 4 years. To our knowledge, this is the first case in which a gastric MALT lymphoma was treated with endoscopic submucosal dissection. In conclusion, endoscopic resection may be recommended as second-line therapy for properly selected patients with gastric MALT lymphoma as it is effective and minimally invasive.

Keyword

Endoscopic resection; Endoscopic submucosal dissection; Marginal zone B-cell lymphoma; Stomach

Figure

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  Fig. 1. Gastric mucosa-associated lymphoid tissue lymphoma. (A, B) Upper endoscopy revealed an elevated, nodular mass on the posterior wall of the gastric mid-body. (C) Endoscopic ultrasonography showed a hypoechoic mass invading the mucosal and submucosal layers (arrow). (D) Computed tomography revealed thickening of the gastric wall (arrow).

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  Fig. 2. Endoscopic submucosal dissection procedure. (A) Marking dots outside of the tumor margin. (B) Circumferential mucosal incision. (C) Submucosal dissection. (D) En bloc resection of the tumor.

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  Fig. 3. Histologic findings. (A) Diffuse dense infiltration of small, atypical lymphocytes (hematoxylin and eosin stain, ×100). (B) Polymorphous lymphoid infiltrates and lymphoepithelial lesions (arrow) (hematoxylin and eosin stain, ×400). Immunohistochemical staining was positive for CD-20 (C) but negative for CD-3 (D).

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