Friday, November 30, 2012

Extranodal marginal zone lymphoma of the dura: a case report.

Extranodal marginal zone lymphoma of the dura: a case report.

Dec 2012

[Article in Japanese]


Department of Neurosurgery, Kagoshima City Hospital.


The authors present the case of a 65-year-old woman who initially was diagnosed as having intracranial dural B-cell malignantlymphoma. She survived more than 9 years after surgery and radiation. We re-examined the specimens pathologically. Histological findings confirmed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) that showed numerous IgG4-positive plasma cells. MALT lymphomas are already recognized as a distinct clinico-pathological entity. A primary dural MALT lymphoma is very rare and has a favorable clinical outcome, and patients are expected to have an excellent long-term survival with local therapy alone.

Wednesday, November 21, 2012

MALT lymphoma in labial salivary gland biopsy from Sjögren syndrome: importance of follow-up in early detection.

MALT lymphoma in labial salivary gland biopsy from Sjögren syndrome: importance of follow-up in early detection.

Nov 2012


Associate Professor, Department of Oral Pathology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina. Electronic address:


Mucosa-associated lymphoid tissue (MALT) lymphomas are known to occur in Sjögren syndrome (SS) patients, but reported cases in labial salivary glands (LSG) are rare. We report a case of 60-year-old female patient with SS who developed MALT lymphoma in the labial salivary glands during a 2-year time interval when she was participating in the Sjögren's International Clinical Collaborative Alliance, an ongoing longitudinal multisite observational study funded by the National Institutes of Health of the United States. At follow-up exam, LSG biopsy showed atypical diffuse infiltration by mononuclear cells of variable size and atypical nuclei affecting the whole specimen with destruction of glandular architecture, leading to a diagnosis of B-cellMALT lymphoma. Computerized tomography and bone marrow biopsy failed to show additional evidence of disease. Clinical, serologic, ocular, histologic and immunohistochemical findings are presented. A "watch and wait" policy was adopted with regular examinations.

A Case of Pulmonary MALT Lymphoma Arising from Lymphocytic Interstitial Pneumonitis.

A Case of Pulmonary MALT Lymphoma Arising from Lymphocytic Interstitial Pneumonitis.

Aug 2012


Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Bucheon, Korea.


Pulmonary mucosa-associated lymphoid tissue-derived (MALTlymphoma is a rare disease. This disorder is considered to be a model of antigen-driven lymphoma, which is driven either by autoantigens or by chronic inflammatory conditions. Low-gradeB-cell MALT lymphoma may develop from a nonneoplastic pulmonary lymphoproliferative disorder, such as lymphocytic interstitial pneumonitis (LIP). A recent estimate predicts that less than 5% of LIP patients acquire malignant, low-grade, B-cell lymphoma. In Korea, there has been no previous report of malignant low-grade, B-cell lymphoma, acquired from LIP. Here, we present the case of a patient with LIP that developed into pulmonary MALT lymphoma, six years after diagnosis.

Tuesday, November 13, 2012

An integrated genomic and expression analysis of 7q deletion in splenic marginal zone lymphoma.

An integrated genomic and expression analysis of 7q deletion in splenic marginal zone lymphoma.



Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom.


Splenic marginal zone lymphoma (SMZL) is an indolent B-cell lymphoproliferative disorder characterised by 7q32 deletion, but the target genes of this deletion remain unknown. In order to elucidate the genetic target of this deletion, we performed an integrative analysis of the genetic, epigenetic, transcriptomic and miRNomic data. High resolution array comparative genomic hybridization of 56 cases of SMZL delineated a minimally deleted region (2.8 Mb) at 7q32, but showed no evidence of any cryptic homozygous deletion or recurrent breakpoint in this region. Integrated transcriptomic analysis confirmed significant under-expression of a number of genes in this region in cases of SMZL with deletion, several of which showed hypermethylation. In addition, a cluster of 8 miRNA in this region showed under-expression in cases with the deletion, and three (miR-182/96/183) were also significantly under-expressed in SMZL relative to other lymphomas. Genomic sequencing of these miRNA and IRF5, a strong candidate gene, did not show any evidence of somatic mutation in SMZL. These observations provide valuable guidance for further characterisation of 7q deletion.

Wednesday, November 7, 2012

H Pylori: The silent killer living inside all of us

H Pylori: The silent killer living inside all of us

By Ritu Dokania, Friday magazine
Nov 7, 2012

It’s silent, insidious and is the cause of gastric symptoms that range from the antisocial to the downright dangerous. But why do so few people know of its existence? Ritu Dokania unveils the mysterious bacteria behind your most embarrassing symptoms...

Alisha, a 30-year-old sales manager, hated going out in public. She refused offers of evenings out with her friends, bypassed busy events and dreaded business meetings with a passion.
It wasn’t that she disliked socialising – she had always been quite gregarious at heart – but chronic gastric symptoms were making her life a misery and she preferred to hide herself away.
Although her symptoms were troublesome, ranging from bloating and mild stomach pain to flatulence and belching, they didn’t seem serious enough to seek medical advice. She did some research online and decided it could be aerophagia, which is caused by swallowing too much air, and tried to treat it by avoiding carbonated drinks and putting an end to her chewing gum and smoking habits. Yet nothing seemed to help.
Several months passed and Alisha was no longer just embarrassed by her symptoms, but was feeling uncomfortable throughout the entire day, while horrible abdominal cramps had started to keep her awake at night.She arranged an appointment with Dr Denesh Gopalan, a gastroenterologist at Welcare Hospital in Dubai. He decided to test her for the little-known bacteria, H Pylori. The diagnosis was positive.
“H Pylori is one of the most widespread infections in the world and around 60 per cent of the UAE population has it,” says Dr Gopalan. “Yet most people don’t know about this silent infection until they start suffering from gastritis or the painful effects of ulcers.”
Its presence is hard to detect, but delayed discovery can give rise to a number of problems as H Pylori is associated not only with ulcers, but also with stomach cancer and gastric malt lymphoma, which is a stomach cancer affecting the white blood cells of the immune system.
Thankfully, once the cause of Alisha’s problems had been pinpointed, her infection was easy to eradicate. “She was put on a course of antibiotics for 14 days, after which the symptoms she had been suffering from for so long subsided remarkably,” says Dr Gopalan.
H Pylori, short for Helicobacter Pylori, is a spiral-shaped bacterium that resides in the stomachs of humans and animals. Although our stomachs are lined with a protective coating to keep it safe from bacterial infections, H Pylori secretes an enzyme that neutralises stomach acid, enabling the bacteria to burrow deep into the walls of our stomachs, where it may survive undetected for decades.
The damage it causes to the mucous coating allows powerful stomach acid to get through to the sensitive lining beneath. Together, the stomach acid and H Pylori irritate the lining of the stomach or duodenum, which can cause ulcers and other complications.
The link between H Pylori and ulcers was a scientific breakthrough. Scientist Barry Marshall discovered it by deliberately ingesting broth infected with the bacteria in order to prove the connection, and in 2005 he and his colleague Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their discovery, which reversed decades of doctrine that ulcers were caused by spicy food and stress.
The Centers for Disease Control and Prevention in Atlanta estimates that two-thirds of the world’s population is infected with the bacterium, making it the most widespread infection in the world.
It is most likely acquired by the ingestion of contaminated food or water, which can happen via faecal matter if food is prepared by people who do not wash their hands after using the bathroom, or in poor sanitary conditions. It can spread from person to person via saliva or by sharing food utensils and is most common in socio-economic groups characterised by crowded living conditions.
Symptoms and implications
H Pylori is often asymptomatic, meaning most people with the infection will never have any signs or symptoms. When symptoms do occur they may include burping, bloating, heartburn, oesophageal reflux, diarrhoea, constipation, flatulence and upper- and mid-abdominal pain. Difficulty losing weight may also be attributed to H Pylori, Dr Gopalan says. Having the infection causes stress and eventually cortisol.
H Pylori is also the leading cause of gastritis, an inflammation of the stomach lining. It is responsible for over 90 per cent of all duodenal ulcers and nearly 80 per cent of all gastric ulcers.
“This pernicious bacteria, which survives so easily in our stomachs, should be exterminated before it does serious harm,” says Dr Gopalan. “While it can remain in the human stomach for a long time without causing any symptoms, it may manifest into more serious diseases over time – one to two per cent of infected people are at risk of stomach cancer and the cancer gastric malt lymphoma is eight times more common in people with H Pylori than in those not infected.”
Apart from these diseases, medical researchers and doctors believe that H Pylori may be implicated in a number of non-digestive conditions including cardiovascular disorders, migraine and Raynaud’s disease (impaired circulation in the hands and feet). Surprisingly, it may also cause depression and anxiety. The happy chemical, serotonin, is largely seen in a healthy digestive system and damage to your stomach by H Pylori will lead to a shortage of this important chemical.

Detection, treatment and prevention

“When I tell my patients about this bacteria, seven out of ten of them will never have heard of it before,” says Dr Gopalan. “But I am more surprised to see that even physicians often do not think to test for this bacteria when a patient complains about the common symptoms of this infection.”

A patient’s breath can be a typical warning sign, says Dr Gopalan, as reflux directly from the stomach or higher levels of periodontal gum disease caused by the bacteria can give it a strong smell. Testing for H Pylori infection may be performed on blood, stool or breath samples or through biopsies of tissue from the lining of the gastrointestinal tract obtained during endoscopy.
H Pylori is successfully eradicated in 80 per cent of cases, but it can be a tough infection to treat, says Dr Gopalan, as it often resides in the deepest layers of the stomach. It is also important that the antibiotics are prescribed carefully.
“H Pylori quickly becomes resistant to several antibiotics when given one at a time,” says Dr Gopalan. For this reason, a ‘triple therapy’ is often employed, which consists of two types of antibiotics and a proton pump inhibitor (PPI), which is used to decrease the stomach’s acidity, allowing the inflamed stomach lining to heal. The treatment is given for ten to 14 days according to the presence and severity of the infection. After a month, the test is repeated to see if the infection has cleared.
“Some antibiotics that are recommended elsewhere in the world might not be suitable in UAE due to the bacteria’s resistance pattern here,” warns Dr Gopalan. “It is advisable to check with your doctor about whether the antibiotic prescribed is the correct one for your particular geographical area.”
Since the source of H Pylori is not yet fully known, recommendations for avoiding infection have not been made. In general, it is always wise to wash hands thoroughly, only eat food that has been hygienically prepared, and drink water from a safe, clean source.
Certain nutrients, especially vitamins A, C, and E, along with zinc, protect the stomach lining by combating free radicals, so ensure that you are not deficient in any of these. Certain probiotics (healthy bacteria) such as lactobacillus and bifidobacterium may also help protect you from H Pylori.

Saturday, November 3, 2012

A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Type.

A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Type.

July 2012


Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.


Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (extranodal MZL) is a distinct subgroup of non-Hodgkin's lymphoma. Pulmonary extranodal MZL is a rare entity and accounts for less than 0.5% of primary pulmonary malignancies. Only a few cases of simultaneous occurrence of lung cancer and pulmonary extranodal MZL have been reported. A 60-year-old woman was referred to our hospital with a pulmonary nodule. She was diagnosed with lung adenocarcinoma by percutaneous needle biopsy. The protrusions into the left main bronchus were found by accident while performing bronchoscopy during lung cancer evaluation. The bronchial lesions were diagnosed as extranodal MZL. Although the patient underwent surgical resection for the lung adenocarcinoma, the pulmonary extranodal MZL was left untreated; it was monitored during follow-up visits. To our knowledge, this is the first report of synchronous lung adenocarcinoma and primary extranodal MZL of the main bronchus.