Primary esophageal mucosa‐associated lymphoid tissue lymphoma treated by endoscopic submucosal dissection

Primary esophageal mucosa‐associated lymphoid tissue (MALT) lymphoma is rare. There have been few reports about early primary esophageal MALT lymphoma being treated endoscopically. The clinical profile of primary esophageal MALT lymphoma is currently unclear, so it is important to accumulate more information about early esophageal MALT lymphoma. To achieve early detection of esophageal MALT lymphoma, we need more accurate knowledge and information about the macroscopic and morphological features of this tumor. Endoscopic resection is one of the most effective treatments. With respect to the lateral andvertical margins of the resected specimen, endoscopic submucosal dissection (ESD) may be superior to endoscopic mucosal resection for treating early esophageal MALT lymphoma. Here we report the macroscopic appearance of the tumor which is the first successful case of ESD for early esophageal MALT lymphoma.     

Endoscopic ultrasonography for assessment of medical treatment in patients with gastric mucosa‐associated lymphoid tissue lymphoma

Background: Although gastric mucosa‐associated lymphoid tissue (MALT) lymphoma often regresses after medical treatment, it is not known whether submucosal lymphomatous involvement persists. Because sampling error is a problem associated with histological evaluation and endoscopic ultrasonography (EUS) is appropriate for assessing the depth of infiltration in cases of gastric lymphoma, we investigated the value of EUS for assessing the effectiveness of medical treatment. Methods: Twelve patients with gastric MALT lymphoma were treated with Helicobacter pylori eradication therapy and/or chemotherapy. Endoscopic ultrasonography was done at initial staging and after treatment. We used EUS to measure the distance from the surface layer to the deepest part of the hypoechoic area; a distance of less than 1.3 mm was considered normal. Results: The mean depth of the hypoechoic area in MALT lymphoma‐positive biopsy specimens was significantly greater than that in MALT lymphoma‐negative biopsy specimens. In many cases in which MALT lymphoma disappeared after treatment, the depth of the endoscopic ultrasonographic hypoechoic area also decreased to normal. In two cases, however, in which the MALT lymphoma biopsy results were negative but there was no decrease to normal depth, recurrence occurred during follow up. Conclusion: Our results show that measurement of the depth of the hypoechoic area via EUS is useful in assessing the response of gastric MALT lymphoma to treatment. When the depth of the hypoechoic area does not decrease to normal, careful follow up and frequent biopsies are required.     

Endoscopic removal of primary B‐cell mucosa‐associated lymphoid tissue lymphoma of the cecum

A 61‐year‐old woman with a history of positive fecal occult blood test was referred for further evaluation. She was symptom‐free and had no family history of colorectal cancer. Colonoscopy revealed a semipedunculated polyp with a surface of normal appearance. Although a biopsy specimen revealed inflammatory cells including numerous small lymphocytes in the mucosa, a definitive diagnosis was not made. Four weeks later, endoscopic removal using the submucosal injection method was performed for diagnosis as well as treatment. The tumor measured 14 × 13 × 6 mm. The pathological diagnosis was low‐grade B‐cell mucosa‐associated lymphoid tissue (MALT) lymphoma, and the depth of invasion was estimated as the submucosal layer. The case described here suggests that MALT lymphoma should be added to the differential diagnosis of colorectal submucosal tumors, and some cases of them might be resected endoscopically using the submucosal injection method.     

胃黏膜相关淋巴样组织瘤与幽门螺杆菌感染的相关性研究

目的 回顾分析胃黏膜相关淋巴组织（MALT）瘤与幽门螺杆菌（Hp)感染的相关性。方法 收集手术和病理理诊的消化道原发性非霍奇金淋巴瘤35例，行常规病理和免疫组化染色（CD3，CD5，CD10，CD20，CD23，CD45RO，Kappa,Lamda,Cyclinl,Ki67,TUNEL)重新作出病理学评价。同时观察Hp感染情况。结果 （1）MALT瘤共21例，其中胃MALT瘤16例，小肠1例，结肠4例。（2）胃MALT瘤中，除3例因切片均为癌组织无法判定有无Hp感染以外，余13例Hp均为阳性。（3）胃MALT瘤中，Ⅰ1期2例，Ⅱ1期5例，ⅡE期9例，（4）内镜误判为胃癌者3例，误判为巨大肥厚性胃炎者1例，误判为萎缩性胃炎者1例，诊断为慢性胃炎者5例，6例患者系胃镜活检确诊。（5）1例经3个疗程抗Hp治疗，病变完全消退，Hp转阴，经内镜及病理检查随访3年未见复发。结论 （1）胃MALT瘤与Hp感染关系密切，（2）抗Hp治疗可治愈早期MALT瘤。     

胃粘膜相关淋巴组织淋巴瘤的内镜下表现

目的 胃粘膜相关淋巴组织淋巴瘤（ＭＡＬＴ淋巴瘤）的内镜特征。方法 对１９例胃ＭＡＬＴ淋巴瘤患者的临床资料进行回顾分析。结果 胃ＭＡＬＴ淋巴瘤的内镜下表现呈多样性改变。病变主胃体最多（７８．９％）,主要病变形态包括溃疡（６３．２％）、肿块（１５．８％）、浸润病变（１５．８％）及糜烂（５．３％）。大多数２（７３．７％）有较典型的恶性征象,但少数可无典型恶性征象,甚至仅表现为一般的炎症及糜烂。本组病例内     

Large mucosa‐associated lymphoid tissue lymphoma simulating multiple polypoid lesions at the cecum and rectum

Herein we describe a case of mucosa‐associated lymphoid tissue (MALT) lymphoma of the cecum and rectum with the Leser–Trélat sign. A 76‐year‐old Japanese woman was admitted to the Harima Hospital of Ishikawajima‐harima Heavy Industries, Health Insurance Society for hematochezia. Colonoscopy showed two large elevated tumors, one in the cecum and the other in the rectum. Biopsy was not diagnostic. Endoscopic snare loop biopsy specimens from both tumors were diagnosed as MALT lymphoma. After staging to IIE, the patient underwent surgery. Macroscopically, the cecal tumor was elevated with a large and deep depressed region, measuring 40 × 35 mm. The rectal lesion was a large elevated tumor, measuring 80 × 70 mm. Histologically, both tumors were diagnosed as MALT lymphoma and there was no lymph node metastasis. The patient received chemotherapy and there is no evidence of recurrence 1 year after surgery. We present this case to show that colorectal MALT lymphoma can present as a large tumor, even in early clinical stages, that multiple lesions should be anticipated and that surgical treatment is needed in these cases.     

Mucosa‐associated lymphoid‐tissue lymphoma. Should we perform a colonoscopy in multiorgan involvement?

Mucosa‐associated lymphoid tissue (MALT) lymphoma is the most frequent non‐Hodgkin lymphoma in the gastrointestinal tract, but colon involvement has only been reported in multiorgan lymphoma. We present a rare case of a woman with MALT involvement of eye conjunctiva, tonsils, stomach, duodenum and colon. In selected cases like this, with multiorgan involvement, we recommend performing colonoscopy, with biopsies for immunohistochemistry with CD10 and cyclin D1 for differential diagnosis with other entities with different prognosis, such as follicular lymphoma, and mantle cell lymphoma, respectively.     

Successful treatment of an enormous rectal mucosa-associated lymphoid tissue lymphoma by endoscopic full-thickness resection: A case report

BACKGROUNDColorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy.CASE SUMMARYA 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C¹³-urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography–CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis. CONCLUSIONThis case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.     

Gastric mucosa‐associated lymphoid tissue lymphoma and Helicobacter pylori infection

OBJECTIVE: Numerous studies have demonstrated the role of Helicobacter pylori infection in the pathogenesis of gastric MALT lymphoma and the present study aimed to analyze this correlation in Chinese patients. METHODS: Thirty‐five cases of primary gastrointestinal non‐Hodgkin's lymphoma that had been surgically resected and pathologically examined during the past 20 years were collected. The tissue samples were re‐examined by a physician from the pathology department. Immunohistochemical staining and H. pylori tests were conducted. The clinical diagnosis of gastric MALT lymphoma and the results of therapy were analyzed. RESULTS: According to the immunohistochemistry results, 21 cases were MALT lymphoma, and of these 16 were gastric MALT lymphoma, one was intestinal MALT lymphoma and four were colonic MALT lymphoma. Of the 16 samples of gastric MALT lymphoma, 13 were positive for H. pylori infection and three could not be evaluated because the sample was full of cancer cells. Of the cases of gastric MALT lymphoma, two were stage I₁, five were stage II₁, and nine were stage II_E. Eleven patients underwent endoscopy: three were misinterpreted as gastric carcinoma, one was diagnosed as Menetrier's disease, one as chronic atrophic gastritis, and only six cases were correctly diagnosed before surgery. Eradication of H. pylori in one patient with gastric MALT lymphoma resulted in regression of the lesion; that patient was followed up for 3 years without relapse. Fifteen cases underwent surgery and 10 were followed up for 5 years: four relapsed within 1?2 years after operation and six remained well. CONCLUSION: There is a close relationship between H. pylori infection and gastric MALT lymphoma. Early gastric MALT lymphoma can be cured after eradication of H. pylori. The depth of the lesion should be diagnosed by echoendoscopy and therapy should be chosen on the basis of the stage of the disease.     

Extremely rare case of primary esophageal mucous associated lymphoid tissue lymphoma

SJ is a 37-year-old male who presented with one year history of dysphagia, odynophagia and 15 pounds weight loss. He underwent endoscopic evaluation which showed mid esophageal ulcers. It was thought that the cause of the ulcer was the multivitamins and the patient was asked to stop them. Furthermore Esomeprazole therapy was also initiated. Patient’s symptoms persisted but he did not seek any medical attention until about one year later. Meanwhile the patient reported additional 15 pounds of weight loss. We repeated upper endoscopy again which showed evidence of two chronic non bleeding irregular friable ulcerations seen in the mid esophagus, 31 cm from the incisors. Biopsies and frozen section were taken and sent for assessment to the Pathology lab. Immunoperoxidase studies on frozen sections showed the presence of IgM and for most plasma cells IgG. The microscopic and histologic findings were consistent with mucous associated lymphoid tissue lymphoma with plasmocytic differentiation. Computed tomographic scan done showed no evidence of spread to adjacent structures. The patient was referred to oncology and several cycles of radiation and Rituximab therapy were initiated which cured the disease. Subsequent endoscopies with blind biopsies were done which were negative for any neoplastic process.     

Gastric vascular ectasia treated by endoscopic mucosal resection

An 80‐year‐old woman consulted our hospital complaining of general weakness. She had iron deficiency anemia, and upper gastrointestinal endoscopy revealed a small lesion accompanying a small amount of fresh bleeding in the stomach. Close observation of the lesion revealed that it was composed of a local assembly of dilated microvessels. The diagnosis of this patient was gastric vascular ectasia causing anemia. Endoscopic ultrasonography demonstrated that the lesion involved the mucosal and submucosal layers of the stomach, and that there were no large vessels inflowing to or outflowing from the lesion. In the present case, we attempted endoscopic mucosal resection (EMR). The lesion was completely resected by only one procedure of EMR without complications such as bleeding. After the endoscopic treatment, iron deficiency anemia improved. Follow‐up endoscopy performed 1 year later revealed that there was no residual or recurrent lesion. Although there have not been any published reports describing the use of EMR for gastric vascular ectasia, EMR may be a useful endoscopic treatment for this condition.     

78例胃粘膜相关淋巴组织淋巴瘤临床、内镜及病理特征分析

目的：探讨胃粘膜相关淋巴组织淋巴细胞的临床、内镜及病理特征，以提高早期诊断水平。方法：分析手术切除并经病理证实的78例胃粘膜相关淋巴瘤患者的临床、内镜和病理资料。结果：患者男女比例为1．05：1，平均年龄48．2岁，平均病程25．6个月，症状非特异性，以EⅠ2和EⅡ1期病变为主，内镜检查70例结果显示，病变多见于胃窦体，表现为溃疡性，隆起性及浸润性损害，以多灶性，多形性及弥漫性病变为特征。56例胃活检中，组织学结合免疫组化可对41例（73．2％）术前确诊。78例均为B细胞淋巴瘤，高恶性居多，67例（85．9％）幽门螺杆菌阳性。结论：胃粘膜相关淋巴组织淋巴瘤患者内镜改变具特征性。内镜下病变形态识别，多取，深取活检以及同期作免疫组化检查可提高早期诊断准确率。     

Mucosa‐associated lymphoid tissue lymphoma occurring in the transverse colon

A case of primary mucosa‐associated lymphoid tissue lymphoma (MALToma) occurring in the transverse colon is reported. Endoscopic examination revealed a flat and oval‐shaped submucosal tumor‐like lesion, approximately 2 cm in diameter in the transverse colon. The tumor extracted by laparotomy showed proliferation of centrocyte‐like cells positive for L26 immunostaining. The patient was diagnosed as having MALToma in the transverse colon. In this case, although the tumor invasion was limited to the submucosal layer, lymph node involvement was seen. Awareness of the clinical presentation and familiarization of colorectal MALToma are important. We emphasize that even if either antibiotic therapy or surgery is chosen for the therapy of colorectal MALToma, lymph node involvement should generally be taken into consideration, although the tumor invasion was limited to the submucosal layer.     

胃黏膜相关淋巴组织淋巴瘤临床研究及随访

目的探讨胃黏膜相关淋巴组织淋巴瘤的临床特征及治疗策略。方法采用回顾性方法对32例经组织学确诊的胃黏膜相关淋巴组织淋巴瘤进行随访。结果32例患者中多数起病隐匿，上腹痛为主要症状，也有以消化道出血入院者。内镜下病变主要分布在胃窦部，以隆起型和溃疡型表现为主。首次胃镜检查约25％获正确诊断。本组病例幽门螺杆菌感染率约为88％。20例（62．5％）接受了手术治疗，15例（46．88％）行幽门螺杆菌根除治疗，其中，3例早期阶段患者获得组织学完全缓解。结论胃黏膜相关淋巴组织淋巴瘤的临床表现、内镜下特征和病理特点的认识有待进一步提高。对早期阶段患者幽门螺杆菌治疗当属首选。     

早期胃黏膜相关淋巴组织淋巴瘤患者52例的临床分析

目的 探讨早期胃黏膜相关淋巴组织（MALT）淋巴瘤患者的临床特点及抗幽门螺旋杆菌（Hp）治疗和抗肿瘤治疗的疗效。方法 收集2003年4月至2013年5月在天津医科大学附属肿瘤医院确诊并治疗的早期胃MALT淋巴瘤患者52例的病例资料。对Hp感染的患者进行抗Hp治疗。对抗Hp治疗失败的患者进行抗肿瘤治疗。结果 52例早期胃MALT淋巴瘤患者中,Hp感染率为88.4%。抗Hp治疗的有效率为91.3%。18例患者进行抗肿瘤治疗,有效率为66.7%。52例患者5年的总生存率为92.3%,5年无疾病进展生存率为83.1%。结论 对于早期胃MALT淋巴瘤患者,抗Hp治疗是合理和有效的治疗方法。抗Hp治疗失败的患者应进行抗肿瘤治疗,从而使患者得到长久的获益。     

Clinicopathological features of gastric mucosa-associated lymphoid tissue lymphoma: A comparison with diffuse large B-cell lymphoma without a mucosa-associated lymphoid tissue lymphoma component

BACKGROUND AND AIMS: The aim of this study was to clinicopathologically distinguish the pathogenesis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma without a MALT lymphoma component (DLL). METHODS: We investigated clinicopathological features of these gastric lymphomas including age, sex ratio, tumor location and depth, macroscopic appearance, and infection with Helicobacter pylori of these gastric lymphomas and hepatitis viruses in 24 patients with gastric low-grade MALT lymphoma, 10 patients with high-grade MALT lymphoma, and 19 patients with DLL. The frequency of H. pylori infection in lymphoma patients was compared with that in age- and sex-matched control subjects. RESULTS: There was a predominance of females with MALT lymphoma (male to female ratio, 8/16 for low-grade MALT lymphomas and 1/9 for high-grade MALT lymphomas), and there was a predominance of males with DLL (male to female ratio, 13/6); the ratios differed significantly (P < 0.05). Ninety-two percent of low-grade MALT lymphomas and 80% of high-grade MALT lymphomas were confined to the mucosal and submucosal layers, but lymphoma cells invaded the muscular layer or more deeply in 74% of DLL. Helicobacter pylori infection occurred significantly more often in patients with low-grade MALT lymphoma than in age- and sex-matched controls (96 vs 67%, P < 0.01). Conversely, the frequency of H. pylori infection in DLL patients did not differ from that in controls. CONCLUSIONS: These data suggest that H. pylori infection may be associated with the development of gastric MALT lymphoma, but not DLL, and that MALT lymphoma and DLL may have a different pathogenesis.