The gastric MALT lymphoma. An unforeseen model for studying the pathogenesis of the limphomas

The gastric MALT lymphoma. An unforeseen model for studying the pathogenesis of the lymphomas

Recenti Prog Med. 2009 Jun

Savio A.
Unità Funzionale di Istopatologia, Laboratorio di Patologia Clinica ed Istocitopatologia, Ospedale S. Orsola Fatebenefratelli, Brescia. antonellasavio@bresciaonline.it

MALT lymphoma is a low-grade lymphoma originating from the mucosa associated lymphoid tissue. It is the third most frequent non-Hodgkin B-cell lymphomas. One third of the cases is primary gastric. The causal association between Helicobacter pylori infection and gastric MALT lymphoma is proved by numerous clinical and experimental studies. The most dramatic evidence supporting a pathogenetic role for H. pylori in gastric MALT lymphoma is remission of the tumour following eradication with antibiotic therapy. However, the evolution of a H. pylori infection towards lymphoma is an exceptional event which takes place probably due to the concurrence of host, environmental and bacterial strain factors. Gastric MALT lymphoma is currently the only malignant neoplasia that can be cured by a simple antibiotic therapy. In early stage cases the Helicobacter pylori eradication is the first line therapy as it obtains stable remissions in most of the cases. Surgical treatment of this disease has been completely abandoned. The role of chemio and radiotherapy is limited to the few cases non-responders to the antibiotic therapy. This paper offers a wide and updated review of the literature about gastric MALT lymphoma. Practical points for the clinical management are also given, in keeping with the European Guidelines that will be shortly published.

PubMed

Primary Low-grade and High-grade Gastric MALT-lymphoma Presentation: A Systematic Review.

Primary Low-grade and High-grade Gastric MALT-lymphoma Presentation: A Systematic Review.
J Clin Gastroenterol. 2009 Sep 9

Zullo A, Hassan C, Andriani A, Cristofari F, Cardinale V, Spinelli GP, Tomao S, Morini S.
*Gastroenterology and Digestive Endoscopy daggerHaematology, "Nuovo Regina Margherita" Hospital double daggerDepartment of Experimental Medicine, "La Sapienza" University, Rome, Italy.

GOALS: To assess the clinical and endoscopic presentation of primary gastric lymphoma.

BACKGROUND: Remission rate and long-term survival in patients with gastric lymphoma mainly depend on disease stage at diagnosis. Series reporting clinical and endoscopic presentation of gastric lymphoma are generally small and heterogeneous.

STUDY: Systematic review with pooled-data analysis assessing clinical and endoscopic presentation of primary gastric lymphoma.

RESULTS: Data regarding 2000 patients were collected. Overall, males were slightly more prevalent, alarm symptoms were absent in near half of the patients, lymphoma was diagnosed in a stage less then I in one-third of the patients, and Helicobacter pylori infection was present in 88.8% of considered patients. At endoscopy, the ulcerative type was the most frequent presentation, although low-grade lymphoma was diagnosed on normal/hyperemic gastric mucosa in 9% of cases. Patients with high-grade lymphoma presented alarm symptoms (anemia and/or melena and/or hemorrhage, persistent vomiting, weight loss), an exophytic or ulcerative lesion, a stage III-IV, and a H. pylori negative status more frequently than low-grade lymphoma cases.

CONCLUSIONS: Our pooled-data analysis showed that gastric lymphoma is still disappointingly diagnosed in an advanced stage in a large number of patients. This is probably due to presence of nonspecific symptoms at initial clinical presentation and/or a normal appearing mucosa at endoscopic observation in the early stages.

Lippincott, Williams & Wilkins

Primary gastric lymphoma: a retrospective series of 35 cases

Primary gastric lymphoma: a retrospective series of 35 cases

Tunis Med. 2008 May
Ennibi K, Mikdame M, Rabhi M, Jroundi I, Benkirane A, Chaari J, Toloune F.
Service de Médecine interne A. Hôpital Militaire d'Instruction Mohammed V. Rabat. Maroc.

BACKGROUND: Primary gastric non Hodgkin's lymphoma (PGNHL) is the most common site of extranodal malignant lymphoma. It is a rare subtype of malignancy, for which no consensus exists about treatment.

AIM: The purpose of This paper was to assess the managemnt of PGNHL.

METHODS: Between January 1992 and December 2001, 35 patients were retrospectively evaluated.

RESULTS: Of the 35 patients, with a mean age of 44 years old Signs and symptoms are unspecific. 20 (57.1%) were in stage IE/IIE1. 15 patients (42.8%) were in stage IIE2,IIIE,IVE. These patients were treated with primary surgery with or without chemotherapy (11; 31.4%); primary chemotherapy (CT) alone with surgery in one patient (21; 60%) and three patients with gastric MALT lymphoma were treated by Helicobacter pylori eradication. The 5 year survival rates of the 35 patients are 62, 86%. There was no significant difference in the 5 year survival rate between the patients with low grade lymphoma and the patients with large grade lymphoma (75% versus 60%, P = 0.467). The 5-year survival rates for stage I/IIE1 and IIE2/III/IV patients were 80%, 53.3% respectively (p less then p =" 0.05).

CONCLUSIONS: This study suggested that primary surgical resection may be important factor predicting the long-term survival of patients with primary gastric NHL. H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma.

PubMed

Association between thymic MALT lymphoma and Sjögren's syndrome

Association between thymic MALT lymphoma and Sjögren's syndrome

Rev Pneumol Clin. 2009 Apr

Giroux Leprieur E, Antoine M, Gounant V, Copie-Bergman C, Lavole A, Milleron B.
Unité fonctionnelle d'oncologie thoracique, service de pneumologie et réanimation respiratoire, hôpital Tenon, 75020 Paris, France. etiennegl@hotmail.com

INTRODUCTION: Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare pathology, often associated with autoimmune diseases. The authors report the case of an Asian woman with Sjögren's syndrome.

OBSERVATION: A 48-year-old Chinese woman, without past medical history and a non-smoker, presented an alteration in her overall condition, dyspnoea at exercise, inflammatory polyarthralgia, and a dry eye and mouth syndrome over the last few months. Thoracic tomodensitometry detected an anterior heterogenic cystic mediastinal mass. A mediastinotomy was performed. The diagnosis of the surgical biopsy was thymic MALT lymphoma. The authors also diagnosed Sjögren's syndrome with the presence of four diagnostic criteria. Chemotherapy by rituximab, cyclophosphamide, vincristine, prednisone induced major tumoral regression. The patient declined surgery and will be monitored.

CONCLUSION: Thymic MALT lymphoma is a rare pathology. There is a high correlation with autoimmune diseases, like Sjögren's syndrome. Its appearance is that of an anterior mediastinal mass with a cystic component. The treatment is not well codified and is most often based on surgical resection, eventually followed by chemotherapy or radiotherapy. As far as the authors know, this is the second case of thymic MALT lymphoma treated by exclusive chemotherapy.

EMConsulte

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