A Case Report of Helicobacter Pylori Negative Gastric MALT Lymphoma with Monoclonal Gammopathy

Eui Kyung Hwang; Eun Jung Jang; Sun Mi Kim; Seong Hyun Jeong; Hyun Woo Lee; Seok Yun Kang; Jin Hyuk Choi; Jae Ho Han; Jang Hee Kim; Myung Wook Kim; Byun Moo Yoo; Joon Seong Park

doi:10.5045/kjh.2009.44.4.261

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Hwang, Jang, Kim, Jeong, Lee, Kang, Choi, Han, Kim, Kim, Yoo, and Park: A Case Report of Helicobacter Pylori Negative Gastric MALT Lymphoma with Monoclonal Gammopathy

Case Report

Korean J Hematol 2009;44(4):261-267.

Published online: 20 December 2009

DOI: https://doi.org/10.5045/kjh.2009.44.4.261

A Case Report of Helicobacter Pylori Negative Gastric MALT Lymphoma with Monoclonal Gammopathy

Eui Kyung Hwang, M.D.¹, Eun Jung Jang, M.D.¹, Sun Mi Kim, M.D.¹, Seong Hyun Jeong, M.D.¹, Hyun Woo Lee, M.D.¹, Seok Yun Kang, M.D.¹, Jin Hyuk Choi, M.D.¹, Jae Ho Han, M.D.², Jang Hee Kim, M.D.², Myung Wook Kim, M.D.³, Byun Moo Yoo, M.D.⁴, Joon Seong Park, M.D.^1,

¹Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea

²Department of Pathology, Ajou University School of Medicine, Suwon, Korea

³Department of Surgery, Ajou University School of Medicine, Suwon, Korea

⁴Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea

Correspondence to：Joon Seong Park, M.D. Department of Hematology-Oncology, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721 Korea Tel: ＋82-31-219-5989, Fax: ＋82-31-219-5983 E-mail: jspark65@ajou.ac.kr

Received 12 June 2009 Revised 15 November 2009 Accepted 18 November 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymphomas of mucosa-associated lymphoid tissue (MALT) comprise 7% of all newly diagnosed non-Hodgkin's lymphomas. Helicobacter pylori (H. pylori) negative gastric MALT lymphomas account for 28 to 45% of gastric MALT lymphomas. H. pylori infection has a close relationship with most gastric low-grade B cell lymphomas of the MALT type. Monoclonal gammopathy can be seen in 36% of the patients and negatively associated with responses to eradication of H. pylori in gastric MALT lymphoma. Here, we describe a case of H. pylori negative MALT lymphoma that arose from the stomach with massive plasmacytic differentiation mimicking an extramedullary plasmacytoma with monoclonal gammopathy, and that was cured by total gastrectomy, chemotherapy and radiotherapy.

Keywords: Helicobacter pylori negative, Gastric B cell lymphoma of mucosa-associated lymphoid tissue type, Monoclonal gammopathy

References

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Fig. 1.

Results of serum protein electrophoresis showed an abnormal band of protein between β and γ fractions (arrows, panel A & B). The band was identified by immunoelectrophoresis as an IgM lambda light chain component (panel C).

Fig. 2.

Esophago-Gastro-Duode-noscopic findings revealed multiple shallow ulcerations spread on entire stomach. (A, gastric fundus; B, gastric mid-body).

Fig. 3.

Endoscopic Ultrasonographic finding showed that the gastric lesions were usually limited only to mucosa and submucosa. However, some focal area (arrows) showed infiltrations reached up to lamina propria.

Fig. 4.

The pathology of total gastrectomy specimen. (A) Pathologic gross findings of the stomach showed multiple ulcerations (arrows) similar to endoscopic findings. (B) H&E stain (×200) of the stomach shows differentiated or undifferentiated plasma cells packed in mucosa and submucosa layer just like plasmacytoma.

Fig. 5.

Immunohistochemical stains (×200) in stomach showed that the putative cells expressed CD79a and Ig M, lambda, but did not express CD20. According to strong expression of CD79a, common marker of plasma cells, these findings suggest rather extramedullary plasmacytoma of the stomach than gastric MALT lymphoma.

Fig. 6.

Results of immunohistochemical stains (×200) in lymph node. Unlike to the stomach, the infiltrated cells expressed CD20 strongly in the lymph node.

Fig. 7.

Esophago-Gastro-Duode-noscopic findings revealed post total gastrectomy with Billoth I anastomosis status, not remarkable multiple shallow ulcerations spread on entire stomach. (A, gastric fundus; B, gastric mid-body).

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