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Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is the most common form of primary extranodal lymphomas. In most cases, it is developed as multifocal and mucosal lesions, and its initial diagnosis is made by biopsy of suspicious lesions on endoscopy. However, when gastric MALT lymphoma afflict submucosal site without typical mucosal lesion, further procedures are necessary for diagnosis, such as endoscopic mucosal resection and endoscopic ultrasonography. We recently experienced two cases of submucosal tumor-like gastric MALT lymphoma. Both cases were without any mucosal lesion. One case was confirmed by endoscopic mucosal resection, and the latter was by wedge resection. Treatment modalities included endoscopic mucosal resection, surgery, H. pylori eradication, and/or chemotherapy. Both cases achieved complete remission until our 18 months’ and 16 months’ follow up.
REFERENCES
1. Lepicard A, Lamarque D, Lé vy M, et al. Duodenal mucosa-associated lymphoid tissue lymphoma: treatment with oral cyclophosphamide. Am J Gastroenterol. 2000; 95:536–539.
2. Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med. 1994; 330:1267–1271.
3. Rhee JC, Lee HY, Rhee PL, et al. Endoscopic findings of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Korean J Gastrointest Endosc. 1997; 17:125–132.
4. Kim YS, Han CH, Park JH, et al. A case of gastric MALT lymphoma presenting as a submucosal tumor (SMT) like lesion, diagnosed by endoscopic mucosal resection. Korean J Gastrointest Endosc. 2004; 29:75–79.
5. Hwang IR, Kim JW, Park SM, Kim HR, Min YI. Primary gastric non Hodgkin lymphoma: clinical presentation and endoscopic diagnosis. Korean J Gastroenterol. 1996; 28:11–18.
6. Chan JK. The new World Health Organization classification of lymphomas: the past, the present, and future. Hematol Oncol. 2001; 19:129–150.
7. Isaacson P, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer. 1983; 52:1410–1416.
8. Hyjek E, Isaacson PG. Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis. Hum Pathol. 1988; 19:1315–1326.
9. Hyjek E, Smith WJ, Isaacson PG. Primary B-cell lymphoma of salivary glands and its relationship to myoepithelial sialadenitis. Hum Pathol. 1988; 19:766–776.
10. Addis BJ, Hyjek E, Isaacson PG. Primary pulmonary lymphoma: a re-appraisal of its histogenesis and its relationship to pseudolymphoma and lymphoid interstitial pneumonia. Histopathology. 1988; 13:1–17.
11. Wotherspoon AC, Diss TC, Pan LX, et al. Primary low-grade B-cell lymphoma of the conjunctiva: a mucosa-associated lymphoid tissue type lymphoma. Histopathology. 1993; 23:417–424.
12. Kim JH, Kim WS, Ko YH, et al. Clinical investigation of gastric MALT lymphoma. Korean J Med. 2001; 61:417–423.
13. Kahl BS. Update: gastric MALT lymphoma. Curr Opin Oncol. 2003; 15:347–352.
14. Isaacson PG, Spencer J. Malignant lymphoma of mucosa-associated lymphoid tissue. Histopathology. 1987; 11:445–462.
15. Mehra M, Agarwal B. Endoscopic diagnosis and staging of mucosa-associated lymphoid tissue lymphoma. Curr Opin Gastroenterol. 2008; 24:623–626.
16. Shim CS, Lee JS, Kim JO, et al. A case of primary esophageal B-cell lymphoma of MALT type, presenting as submucosal tumor. J Korean Med Sci. 2003; 18:120–124.
17. Kim DR, Jeong WS, Kwon YD, et al. A case of low grade MALT lymphoma presented as submucosal tumor without mucosal lesion. Korean J Gastrointest Endosc. 2002; 25:103–106.
18. Nobre-Leitä o C, Lage P, Cravo M, et al. Treatment of gastric MALT lymphoma by Helicobacter pylori eradication: a study controlled by endoscopic ultrasonography. Am J Gastroenterol. 1998; 93:732–736.
19. Rosin D, Rosenthal RJ, Bonner G, Grove MK, Sesto ME. Gastric MALT lymaphoma in a Helicobacter pylori-negative patient: a case report and review of the literature. J Am Coll Surg. 2001; 192:652–657.
20. Pinotti G, Zucca E, Roggero E, et al. Clinical features, treatment and outcome in a series of 93 patients with low-grade gastric MALT lymphoma. Leuk Lymphoma. 1997; 26:527–537.
Fig. 1.
(A) Endoscopic findings. A prominently elevated submucosal tumor-like lesion covered with normal mucosa was seen on the posterior wall of lower body. (B) Endoscopic ultrasonographic finding. An about 1.1×0.6 cm, hypoechoic lesion with latticework structure was seen in the deep mucosal and superficial submucosal layer.
Fig. 2.
(A) Endoscopic findings. The submucosal tumor-like lesion was resected by endoscopic mucosal resection after circumferential precutting. (B) Specimen of endoscopic mucosal resection.
Fig. 3.
Histological findings. (A) Proliferated lymphoid tissue was mainly located in the submucosal layer (H&E, ×20). (B) Lymphoepithelial lesions which neoplastic lymphocytes invaded gastric glandular epithelium (H&E, ×200). (C) CD20 positive neoplastic cells infiltrated gastric glands, showing characteristic lymphoepithelial lesion (CD20, ×400). (D) Pancytokertin immunostain highlighted gastric glands which were destructed by infiltrating neoplastic lymphoid cells (cytokeratin, ×200).
Fig. 4.
(A) Endoscopic finding. A buldging mass with intact over-lying mucosa was seen on the cardia. Several tiny erosions were seen on its top. (B) Endoscopic ultrasonographic finding. An about 1.6 ×1.4 cm hypoechoic lesion with suspicious latticework structure was seen in the submucosal layer.
Fig. 5.
(A) Gross appearance of wedge resected specimen. The epicenter of the mass was in the submucosa. The cut surface of the mass was tan yellow and lobulated. (B) Neoplastic lymphoid cells infiltrated into the muscularis propria (H&E, ×40). (C) Neoplastic lymphoid cells showed small nuclei and clear cytoplasm and invaded gastric glands (H&E, ×200). (D) CD20 positive neoplastic cells diffusely effaced the submucosa and infiltrated into the mucosa (CD20, ×100).
Table 1.
Summary of Reported Cases of Gastric MALT Lymphoma Presenting as a Submucosal Tumor-like Lesion
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