MALT lymphoma: epidemiology, clinical diagnosis and treatment

Abstract

Primary gastric lymphoma (PGL) represents a rare pathology, which can be easily misdiagnosed because of unspecific symptoms of the digestive tract. Histologically, PGL can vary from indolent marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) to aggressive diffuse large B-cell lymphoma (DLBCL). During the years, clinical trials revealed the important role of Helicobacter pylori (H. pylori) in the pathogenesis of gastric MALT lymphoma. Infection with Helicobacter pylori is an influential promoter of gastric lymphomagenesis initiation. Long-term studies revealed that eradication therapy could regress gastric lymphomas.

An unusual presentation of gastric mucosa-associated lymphoid tissue (MALT) lymphoma following blunt abdominal trauma

“…MALT lymphomas were first characterised by pathologists Peter Isaacson and Dennis Wright in 1983 5. MALT lymphomas are considered low-grade malignancies; however, they can transform into high-grade lymphomas 3. They typically occur between the ages of 50 and 60 years and half of all MALT lymphomas occur in the gastrointestinal tract of which 85% are located in the stomach 3 4…”

“…The clinical presentation of MALT lymphomas is heterogenous with some patients reporting gastrointestinal symptoms such as epigastric pain, nausea, vomiting, dyspepsia and weight loss while others report symptoms typical of B-cell lymphoma including fever or night sweats 3. The former gastrointestinalsymptoms are non-specific and thus often lead to a delay in diagnosis 4.…”

“…The establishment of a diagnosis of MALT is usually made at endoscopy and the appearance of the gastric mucosa may include irregularly shaped superficial erosions, shallow ulcers, enlarged rugal folds, intragastric nodularity or thickened gastric walls 3 7. However, in many cases, including the present, the mucosal appearance may not be diagnostic.…”

“…Primary gastric lymphomas (PGL) while an uncommon gastric primary malignancy accounting for 3%–5% of stomach malignant tumours,1 represents ~40% of all extranodal lymphomas 2. PGL is categorised into two histological subtypes namely diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue (MALT) lymphoma 3. MALT lymphomas may occur throughout the body with 50% located in the gastrointestinal tract of which 85% are gastric in origin 4.…”

“…MALT lymphomas may occur throughout the body with 50% located in the gastrointestinal tract of which 85% are gastric in origin 4. Presentation is varied and may include epigastric pain, nausea, vomiting, dyspepsia, weight loss, chronic manifestations of gastric bleeding with anaemia or even typical B-cell lymphoma symptoms such as fever or night sweats can be present 3. We report a unique presentation of an uncommon condition and highlight the importance of multidisciplinary discussion in the management of neoplastic disease.…”