A case of pancreatic mucosa-associated lymphoid tissue (MALT) lymphoma

A case of pancreatic mucosa-associated lymphoid tissue (MALT) lymphoma

Nippon Shokakibyo Gakkai Zasshi. 2008 Dec
Miwa I, Maruyama Y, Kageoka M, Nagata K, Ohata A, Noda Y, Ikeya K, Koda K, Watanabe F.
Department of Gastroenterology, Fujieda City General Hospital.

A 77-year-old woman underwent abdominal ultrasonic diagnosis in a screening test for diabetes mellitus. A 65x45mm tumor with low echo level was revealed and located from the uncinate process of the pancreas to the body. Contrast-enhanced computed tomography demonstrated the pancreas had a low density area in the arterial phase and a comparable area in the equilibrium phase, compared with the parenchyma of the normal pancreas. Gallium-scintigraphy showed strong accumulation, consistent with the tumor. Mucosa-associated lymphoid tissue (MALT) lymphoma was diagnosed by endosonography-guided fine-needle aspiration biopsy (EUS-FNAB). Complete remission was achieved after radiation therapy.

STAGE Journal Archive

MALT lymphoma of the rectum: A case report treated by radiotherapy

MALT lymphoma of the rectum: A case report treated by radiotherapy
Cancer Radiother. 2008 Dec

Amouri A, Chtourou L, Mnif L, Mdhaffar M, Abid M, Ayedi L, Daoud J, Elloumi M, Boudawara T, Tahri N.
Service d'hépatogastroentérologie, hôpital Hédi-Chaker, 3029 Sfax, Tunisie.

The mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, skin and breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal MALT lymphoma have been reported in the literature. We report a 46-year-old woman with rectal MALT lymphoma, which regressed after radiotherapy. The patient had rectal bleeding. Colonoscopy showed a pseudonodular and ulcerated big fold in the rectum. Microscopic and immunohistologic studies of the biopsy specimen showed typical features of low grade MALT lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging evaluation, which included computed tomography (CT) of the abdomen, chest, pelvis and a bone marrow biopsy. We attempted to eradicate H. pylori with a 7-day course of omeprazole, amoxycillin, and metronidazole. Eradication was proved successful by endoscopy. Repeated colonoscopy 4months after the end of treatment showed that the rectal tumor had not regressed. Biopsy specimens confirmed the persistent infiltration of lymphoma cells. The patient was considered to be a non-responder to eradication therapy and was indicated for radiotherapy. He underwent a total of 34Gy. Complete regression was confirmed by colonoscopic and histologic examination at 2months after the end of treatment. He was followed up closely with colonoscopy, but no relapse of these lesions was detected after 12 months.

Elsevier

Nodular amyloïdoma associated with primary pulmonary Malt lymphoma

Nodular amyloïdoma associated with primary pulmonary Malt lymphoma

Rev Mal Respir. 2008 Nov

Hourseau M, Virally J, Habib E, Juberthie B, Bienvenu L.
Service d'Anatomie et cytologie pathologiques, Hôpital Robert Ballanger, Aulnay sous Bois, France.

Introduction

Pulmonary amyloïdoma is a nodular formation containing amyloid deposits, which can mimick a pulmonary carcinoma. Its etiologic diagnosis require the search of an underlying infectious disease, a connective tissue disorder or a lymphoma. Case report We report the case of a 73 year old woman, asymptomatic, presenting an incidental pulmonary opacity in the left upper lobe, associated with hilar lymphadenopathies, positive on PET scan. The patient underwent a left superior lobectomy with mediastinal lymphadenectomy. Histologically, the nodule was composed of amylodosis deposits. It was surrounded by a dense lymphoïd infiltrate. The phenotype (CD20+, CD5-, CD3-, CD23-) of the lymphoïd cells, like the demonstration of a lambda light chain restriction permited to pose the diagnostic of pulmonary Malt lymphoma and to characterize the AL lambda type of the amyloïdosis Conclusion Association of amyloïdoma and Malt lymphoma is a rare condition. The histologic diagnosis of lymphoma may be difficult in this case, the lymphomatous process being concealed by the volume of the amyloïd mass. Therefore it is necessary in case of amyloïdoma to search histological signs of Malt lymphoma and to confirm diagnosis by demonstrating a B clonality and a immunoglobulin light chains restriction.

EM Consulte

Antibiotics Effective in Treatment of MALT Lymphoma

Antibiotics Effective in Treatment of MALT Lymphoma

Researchers from Taiwan have reported that treatment of Helicobacter pylori (H. pylori) infection with antibiotics is effective against early-stage, low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach as well as high-grade transformed tumors. The details of this study appeared in the September 21, 2005, issue of the Journal of the National Cancer Institute .

Researchers have long known that H. pylori is associated with a certain type of low-grade non-Hodgkin’s lymphoma referred to as MALT lymphoma. MALT lymphoma develops outside of lymph nodes, most commonly in the stomach, salivary glands, lungs, or thyroid. Treatment of H. pylori infection with antibiotics results in complete disappearance of lymphoma in some patients with early-stage MALT lymphoma of the stomach.

In order to further assess the role of antibiotics in the treatment of patients with early-stage MALT lymphoma of the stomach, researchers in Taiwan evaluated two groups of patients. One group had low-grade MALT lymphoma, while the other had high-grade transformed lymphoma.

The patients with high-grade lymphoma had diffuse large B-cell lymphoma (DLBCL) with features of MALT. Some have speculated that DLBCL(MALT) lymphoma is not dependent on H. pylori and will not be affected by antibiotic treatment.

A large majority of both groups of patients were infected with Helicobacter pylori —94% of the patients with low-grade lymphoma and 100% of the patients with high-grade lymphoma.

Patients were treated with two weeks of antibiotics. The antibiotics were highly effective in both groups:

Antibiotics eliminated the H. pylori infection in 97% of the low-grade patients.

H. pylori infection was eliminated in 92% of the high-grade patients.

Among those whose infection was eliminated:

80% of patients with low-grade lymphoma experienced a complete disappearance of detectable lymphoma.

64% of patients with high-grade lymphoma had a complete disappearance of their disease.
None of the patients who were initially negative for H.pylori and none who had persistent infection after antibiotic treatment experienced a complete disappearance of lymphoma. After roughly five years of follow-up, lymphoma recurred in three (13%) of the patients with low-grade lymphoma; none of the patients with high-grade lymphoma had a recurrence.
The researchers conclude that antibiotic treatment of H. pylori infection is effective for both low-grade MALT lymphoma of the stomach as well as DLBCL(MALT). They recommend additional studies to confirm that antibiotics are an appropriate first-line treatment for early stage, H. pylori-positive DLBCL(MALT).

Comments: These are very interesting results and it will be important to confirm these observations in American patients.

Reference: Chen L-T, Lin J-T, Tai JJ et al. Long-term results of anti-Helicobacter pyloritherapy in early-stage gastric high-grade transformed MALT lymphoma. Journal of the National Cancer Institute . 2005;97:1345-1353.

CancerConsultants

What is gastric MALT lymphoma?

What is gastric MALT lymphoma?
Gastric MALT lymphoma is a type of Non Hodgkin Lymphoma (NHL) affecting the stomach

Treatment options for gastric MALT lymphoma:

The following treatments can be used for gastric MALT lymphomas:
Treatment of Helicobacter pylori infection
Radiation therapy
Surgery
Chemotherapy

Let us look at how these different treatments fit in.

Treatment of H pylori infection:

Many cases of MALT lymphoma of the stomach are strongly associated with infection with H pylori, a bacterium that commonly causes gastritis and stomach ulcers. It has been seen that in those patients with MALT lymphoma who also test positive for H pylori, antibiotics for H pylori may actually control the cancer. In 3 out of 4 patients with early disease, H pylori treatment may result in a complete resolution of the tumor. The disease remains controlled in many patients. Those with complete response may be kept on regular follow-up with endoscopies. Cancer treatment may be kept in reserve for later.

Radiotherapy for MALT lymphoma:

Radiation is the preferred treatment for MALT lymphoma when H pylori is absent, or when anti H pylori treatment fails. Relatively low doses of radiation are given, and these doses nearly always control the lymphoma. Radiotherapy treatment alone can cause complete response in more than 95% of the patients, and most patients remain controlled in the long term.

Surgery for MALT lymphoma of the stomach:

Surgery is an effective treatment of MALT lymphomas of the stomach and results in long term control in most patients. The potential morbidities of surgery are higher than those of radiation, and therefore surgery is less commonly used for treatment. Like radiotherapy, surgery is usually sufficient to control and cure MALT lymphomas that are limited to the stomach.

Chemotherapy for MALT lymphoma:

Chemotherapy is generally used for early stage gstric MALT lymphomas when local teatments fail to control disease or when the disease recurs. For advanced stage lesions chemotherapy is the treatment of choice. Different combination treatments are effective in these slow growing lymphomas.

About.com

Management and long-term follow-up of early stage H. pylori-associated gastric MALT-lymphoma in clinical practice

Management and long-term follow-up of early stage H. pylori-associated gastric MALT-lymphoma in clinical practice: An Italian, multicentre study.

Dig Liver Dis. 2008 Oct 20
Andriani A, Miedico A, Tedeschi L, Patti C, Di Raimondo F, Leone M, Scinotta L, Romanelli A, Bonanno G, Linea C, Giustini M, Hassan C, Cottone M, Zullo A.
Haematology and Gastroenterology Department, San Giacomo Hospital, Rome, Italy.

BACKGROUND/AIM: Data on management and long-term follow-up of Helicobacter pylori-associated MALT-lymphoma in clinical practice are scanty. We evaluate the long-term efficacy of H. pylori eradication on low-grade MALT-lymphoma, and the efficacy of further therapies in refractory patients.

METHODS: This study enrolled patients with stages I-II(1) MALT-lymphoma and H. pylori infection. H. pylori eradication was attempted in all patients. Patients with lymphoma persistence or progression following H. pylori treatments received further lymphoma treatments. Both 5-year and disease-free survivals were calculated.

RESULTS: Sixty patients (stage I/II(1): 50/10) were followed up for a median time of 65 months (range 7-156). H. pylori infection was successfully eradicated in 53 (88.3%) patients following three consecutive therapeutic attempts, and lymphoma regressed in 42 (79.2%) of these patients. Sixteen patients received anti-neoplastic treatments due to either lymphoma persistence or progression, and lymphoma was cured in 14 (87.5%) cases. At follow-up, lymphoma relapsed in 13/42 (30.9%) patients within a median time of 19 months (range 3-41), and all but 1 patient were cured with further therapies. Overall, lymphoma regression was achieved in 56 patients (93.3%). The 5-year and disease-free survivals were 94.7% and 74.6%, respectively.

CONCLUSIONS: In clinical practice, a conservative approach with antibiotic eradication seems to be appropriate management for early-stage MALT-lymphoma, with oncologic therapy being reserved for those patients who fail to respond to H. pylori therapy.

Elsevier

What is MALT Lymphoma

MALT lymphoma

This information is about a specific type of non-Hodgkin lymphoma (NHL), known as MALT lymphoma. It should ideally be read with our general information about non-Hodgkin lymphoma.

MALT lymphoma (or MALToma) is a relatively rare form of non-Hodgkin lymphoma. Most NHL develops in the lymph nodes (nodal lymphoma). MALT lymphoma starts in Mucosa-Associated Lymphoid Tissue, which is lymphatic tissue that is found in other parts of the body such as the stomach, thyroid gland, lungs or the eyes, and is therefore known as extranodal lymphoma.

MALT lymphoma is a cancer of the B-cell lymphocytes. It belongs to the group of marginal zone B-cell lymphomas. Marginal zone lymphoma can be either 'nodal' or 'extranodal'. MALT lymphoma is an extranodal marginal zone B-cell lymphoma. We also produce information about nodal marginal zone B-cell lymphoma.

MALT lymphoma accounts for about one in 20 of all cases of lymphoma. It can occur at any age from early adulthood to old age, but is more common in people over 60. It is slightly more common in women than in men.

Causes of MALT

Many MALT lymphomas affecting the stomach are caused by a type of bacteria called Helicobacter pylori (see Treatment section). The causes of MALT lymphoma in other parts of the body are unknown. MALT lymphoma, like other cancers, is not infectious and cannot be passed on to other people.

Signs and symptoms

The stomach is the most common site for MALT lymphoma, but it may also occur in the lung, the thyroid, salivary gland and other organs such as the intestine.

The symptoms caused by the cancer will vary depending on which organ is affected. When MALT lymphoma develops in the stomach, it may cause symptoms such as indigestion, bleeding into the stomach, and weight loss. Some people experience a loss of appetite and tiredness.

How it is diagnosed

If you have digestive symptoms such as feeling sick, or pain in the area of your stomach, the doctor will arrange for you to have a flexible tube passed down your gullet and into the stomach (endoscopy). Photographs can then be taken of the stomach, and a small sample of cells is taken for examination under a microscope (biopsy).

Additional tests, including blood tests, x-rays, scans and bone marrow samples, are then used to get more information about the type of lymphoma, and how far it has spread in the body. This information is used to help decide which treatment is most appropriate for you.

Staging and grading

Staging

The stage of MALT lymphoma describes whether the lymphoma is affecting only one area of the body – for example, the stomach – or whether it has spread to anywhere else in the body.

It is rare for MALT lymphoma to spread to the lymph nodes, but it can. If it does, the stage refers to how many groups of lymph nodes are affected, where they are in the body, and whether other organs are affected.

Grading

For practical purposes, non-Hodgkin lymphomas are also divided into two groups: low- and high-grade. Low-grade lymphomas are usually slow-growing, and high-grade lymphomas tend to grow more quickly.

MALT lymphoma is usually low-grade and slow-growing. However, it can sometimes change (transform) to a high-grade.

Treatment

Most cases of MALT lymphoma affecting the stomach (approximately 2 out of 3) are caused through infection by a type of bacteria called Helicobacter pylori (often abbreviated to H. pylori). When tests show that the bacteria is present in the tumour tissue, a course of intensive antibiotic treatment and anti-acid treatment, often called triple therapy, will sometimes lead to a remission of the lymphoma. Remission means that the lymphoma disappears and cannot be detected by any of the currently used tests.

For people with MALT lymphomas of the stomach, if antibiotics do not clear the condition, or the disease spreads, other treatments are given. In some circumstances, this may be radiotherapy or surgery. Sometimes chemotherapy may be given as well as radiotherapy or surgery.
When the MALT lymphoma has started in a part of the body other than the stomach, the following treatments may be considered.

Active surveillance (or active monitoring)

Some MALT lymphomas grow very slowly and may not cause any problems for many years. In this situation you may not need to have any treatment for some time, but your doctor will monitor you closely so that if the lymphoma does start to grow you can be given treatment at that time.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. When MALT lymphoma affects the lung or the bowel, chemotherapy is usually given. This is often a relatively simple treatment, and sometimes just involves you taking tablets called chlorambucil.

Occasionally, MALT lymphoma can change (transform) to high-grade lymphoma that needs more intensive chemotherapy. Chemotherapy can still get rid of the lymphoma for many people.

Radiotherapy

Radiotherapy is the use of high-energy rays to destroy cancer cells, while doing as little harm as possible to the healthy cells. Radiotherapy may be given to the affected part of the body. It may also be given with chemotherapy.

Surgery

The lymphoma may be removed during a surgical operation. If the lymphoma is affecting the stomach, the whole stomach may need to be removed (total gastrectomy). This usually involves having all of the stomach removed, along with the lower part of the gullet. The gullet is then joined directly to the small intestine.

Steroid therapy

Steroids are drugs which are often given with chemotherapy to help treat lymphomas. They also help you to feel better and can reduce feelings of sickness.

Clinical trials

New treatments for MALT lymphoma are being researched all the time, and you might be invited by your doctor to take part in a clinical trial to compare a new treatment against the best available standard treatment. Your doctor must discuss the treatment with you, and have your informed consent before entering you into any clinical trial.

Follow-up

When treatment has ended, you will have regular check-ups at the hospital. For lymphomas affecting the stomach this will involve regular endoscopies and biopsies of the stomach to look for signs of the cancer coming back (a recurrence). Other tests may be used for people whose MALT lymphoma affects areas apart from the stomach.

Support

The need for practical and emotional support will of course be individual. For some people with MALT lymphoma, life may seem largely unaffected; for others the diagnosis of cancer may be a cause of great fear and distress. If you would like to discuss the condition, its treatment, or the practical and emotional problems of living with MALT lymphoma, please contact our cancer support service.

Content last reviewed: 01 April 2008 Page last modified: 04 July 2008
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