Journal List > Korean J Gastroenterol > v.56(2) > 1006697

Choi, Kim, Lee, Park, Lee, Ryu, Song, and Park: 2 Cases of Gastric Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Submucosal Tumor-like Lesion

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.

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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.
kjg-56-103f1.tif
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.
kjg-56-103f2.tif
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).
kjg-56-103f3.tif
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.
kjg-56-103f4.tif
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).
kjg-56-103f5.tif
Table 1.
Summary of Reported Cases of Gastric MALT Lymphoma Presenting as a Submucosal Tumor-like Lesion
No Author Sex/Age Site Size (cm) EUS Treatment
Layer Echogenicity Latticework appearance
1 Kim et al17 (2002) M/48 Antrum 4.5×2.5 4th Hypoechoic Not stated Subtotal gastrectomy
2 Kim et al4 (2004) M/48 Midbody 1.5 2nd Hypoechoic Not stated EMR, H. pylori eradication
3 Present case F/46 Lower body 1.1×0.6 2nd, 3rd Hypoechoic Present EMR, H. pylori eradication
4 Present case M/55 Cardia 1.6×1.4 3rd Hypoechoic Present Wedge resection, H. pylori eradication, CTx

  EMR, endoscopic mucosal resection; CTx, chemotherapy.

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