Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy

다국어 초록 (Multilingual Abstract)

It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.

참고문헌 (Reference)

1 Hummel M, "Wotherspoon criteria combined with B cell clonality analysis by advanced polymerase chain reaction technology discriminates covert gastric marginal zone lymphoma from chronic gastritis" 55 : 782-787, 2006

2 Doglioni C, "Società Italiana di Anatomia Patologica e Citopatologia Diagnostica/International Academy of Pathology, Italian division (SIAPEC/IAP). Gastric lymphoma: the histology report" 43 (43): S310-S318, 2011

3 Achyut BR, "Risk of lymphoid follicle development in patients with chronic antral gastritis: role of endoscopic features, histopathological parameters, CagA status and interleukin-1 gene polymorphisms" 57 : 51-56, 2008

4 Xu W, "Repeating gastric biopsy for accuracy of gastric lymphoma diagnosis" 33 : 313-317, 2010

5 Wotherspoon AC, "Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori" 342 : 575-577, 1993

6 Taal BG, "Primary non-Hodgkin lymphoma of the stomach : endoscopic pattern and prognosis in low versus high grade malignancy in relation to the MALT concept" 39 : 556-561, 1996

7 Ferrucci PF, "Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years?" 136 : 521-538, 2007

8 Lim SH, "Prevalence and risk factors of Helicobacter pylori infection in Korea: nationwide multicenter study over 13 years" 13 : 104-, 2013

9 Choi KS, "Performance of gastric cancer screening by endoscopy testing through the National Cancer Screening Program of Korea" 102 : 1559-1564, 2011

10 Rudolph B, "Is the polymerase chain reaction or cure of Helicobacter pylori infection of help in the differential diagnosis of early gastric mucosa-associated lymphatic tissue lymphoma?" 15 : 1104-1109, 1997

11 Stolte M, "Helicobacter pylori gastritis and gastric MALT-lymphoma" 339 : 745-746, 1992

12 Zucca E, "Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up" 21 (21): v175-v176, 2010

13 Zullo A, "Gastric MALT lymphoma : old and new insights" 27 : 27-33, 2014

14 Chung SJ, "Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea" 131 : 2376-2384, 2012

15 Ruskoné-Fourmestraux A, "EGILS consensus report. Gastric extranodal marginal zone B-cell lymphoma of MALT" 60 : 747-758, 2011

16 Kolve M, "Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin’s lymphoma" 49 : 307-315, 1999

17 Shiozawa E, "Clinicopathological comparison of the World Health Organization/Wotherspoon score to the Groupe d’Etude des Lymphomes de l’Adult grade for the post-treatment evaluation of gastric mucosa-associated lymphoid tissue lymphoma" 24 : 307-315, 2009

18 Musshoff K, "Clinical staging classification of non-Hodgkin’s lymphomas(author’s transl)" 153 : 218-221, 1977

19 Nakamura T, "Clinical features and prognosis of gastric MALT lymphoma with special reference to responsiveness to H. pylori eradication and API2-MALT1 status" 103 : 62-70, 2008

20 Wündisch T, "B-cell monoclonality is associated with lymphoid follicles in gastritis" 27 : 882-887, 2003