Abstract
BackgroundGastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis. Rarely, patients with MALT lymphoma may have gastric cancer and have a poor prognosis.Case presentationWe herein report a case in which surgical treatment was achieved for a 72-year-old male patient with gastric and duodenal MALT lymphoma coexisting multiple gastric cancers. He underwent upper endoscopy for epigastric discomfort, which revealed mucosal erosion on the posterior wall of the middle body of the stomach, an elevated lesion on the duodenal bulb, and a raised tumor on the antrum of the stomach. He was diagnosed with gastric and duodenal MALT lymphoma with early gastric cancer. One month after H. pylori eradication, a second upper endoscopy revealed no improvement in the gastric or duodenal mucosa, and areas of strong redness with a shallow recess just below the cardia of the stomach. As a result, a diagnosis of gastric and duodenal MALT lymphoma with two gastric cancers was made. Total gastrectomy with proximal duodenum resection using intraoperative upper endoscopy and regional lymph node dissection was performed. Pathologically, gastric and duodenal MALT lymphoma and three gastric cancers were detected. Since one of them was an advanced cancer, he started taking S-1 after his general condition improved.ConclusionFor early detection of gastric and duodenal MALT lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important. It is necessary to select a suitable treatment, such as H. pylori eradication, endoscopic treatment, surgery, chemotherapy, and irradiation, according to the disease state.
Highlights
ConclusionFor early detection of gastric and duodenal mucosa-associated lymphoid tissue (MALT) lymphoma or gastric cancer, appropriate upper endoscopy and a biopsy are important
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is often caused by Helicobacter pylori and has a good prognosis
Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade lymphoma derived from marginal zone B cells of MALT that occurs in extranodal organs, such as the digestive tract, salivary gland, thyroid gland, lung, bladder, and skin
Summary
Gastric MALT lymphoma is a relatively rare disease and does not show specific symptoms or endoscopic findings, so the early diagnosis is difficult. It is known that gastric cancer sometimes coexists in patients with MALT lymphoma. A careful endoscopic examination is necessary for the early detection of these diseases. It is necessary to carefully consider H. pylori eradication, endoscopic treatment, surgery, chemotherapy, or irradiation depending on the spread, site, and stage of MALT lymphoma or gastric cancer
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