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Gong and Choi: Diagnosis and Treatment of Gastric Mucosa-associated Lymphoid Tissue Lymphoma
Review Article

The Korean Journal of Gastroenterology 2019; 74(6): 304-313.

Published online: 26 December 2019

DOI: https://doi.org/10.4166/kjg.2019.74.6.304

Diagnosis and Treatment of Gastric Mucosa-associated Lymphoid Tissue Lymphoma

Eun Jeong Gong, Kee Don Choi1

Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Kee Don Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-5813, Fax: +82-2-476-0824, keedon@amc.seoul.kr

Received 24 October 2019       Revised 11 November 2019       Accepted 15 November 2019

Copyright © 2019. Korean Society of Gastroenterology

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients' preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.

Keywords: Diagnosis, Helicobacter pylori, Lymphoma, B-cell, marginal zone, Therapeutics

Figures and Tables

Fig. 1

Various endoscopic findings of gastric MALT lymphoma. (A) MALT lymphoma mimicking erythematous gastritis, (B) ulcer scar, (C) polyp, (D) ulcer, (E) mass, and (F) thickened fold. MALT lymphoma, mucosa-associated lymphoid tissue lymphoma.

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Fig. 2

Suggested management algorithm for gastric MALT lymphoma. MALT lymphoma, mucosa-associated lymphoid tissue lymphoma; H. pylori, Helicobacter pylori.

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Table 1

Histologic Scoring System for Gastric MALT Lymphoma

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MALT lymphoma, mucosa-associated lymphoid tissue lymphoma.

Table 2

Recommended Diagnostic Workup in Gastric MALT Lymphoma

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MALT lymphoma, mucosa-associated lymphoid tissue lymphoma; CT, computed tomography; PET, positron emission tomography; IFRT, involved field radiotherapy; FISH, fluorescence in situ hybridization; PCR, polymerase chain reaction.

aRecommended, particularly in the case of the failure of eradication therapy or before initiating systematic therapy.

Table 3

Comparison of the Different Staging Systems for Gastric MALT Lymphoma

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MALT lymphoma, mucosa-associated lymphoid tissue lymphoma; GI, gastrointestinal.

aSubscripts (1 or 2) may be added if both the lymph nodes and adjacent organs are involved.

Table 4

Efficacy of Eradication Therapy in H. pylori-negative Gastric MALT Lymphoma

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H. pylori, Helicobacter pylori; MALT lymphoma, mucosa-associated lymphoid tissue lymphoma; NA, not applicable; IQR, interquartile range.

aNumber of H. pylori-negative patients who underwent H. pylori eradication therapy.

Table 5

GELA Grading System for the Post-treatment Evaluation of Gastric MALT Lymphoma

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GELA, Group d'Etude des Lymphomes de l'Adult; MALT lymphoma, mucosa-associated lymphoid tissue lymphoma; LP, lamina propria.

Notes

Financial support None.

Conflict of interest None.

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Kee Don Choi
https://orcid.org/0000-0002-2517-4109

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