An Unusual Case of Helicobacter pylori Negative Gastric MALToma Presenting as Nodular Gastritis

Abstract

Introduction: MALT lymphomas or MALToma, make up 8% of all B-cell lymphomas. MALTomas can affect many tissues but the gastrointestinal tract is the commonest site affected by the disease of which gastric MALTomas are the most common. Case Report: We present a 50-year-old female who presented with a sharp epigastric pain of 4/10 in intensity after eating, not related to any particular food, lasting for an hour, associated with nausea and bloating, of 6 months' duration. No history of weight loss, fever, chills, fatigue, or anorexia was given. An upper GI series was performed which showed nodular gastritis. Esophagogastroduodenoscopy (EGD) showed nodular mucosa in body and antrum of stomach. Multiple biopsies were taken from them and histopathology showed lymphoplasmacytic infiltrate withn the lamina propria. Giemsa stain was negative for Helicobacter pylori. Immunohistochemistry showed marginal B cell lymphoma - mucosal associated lymphoid tissue with CD 20 positivity. She was given clarithromycin, amoxicillin and lanzoprazole for 4 weeks and a repeat endoscopy was performed twice with same endoscopy findings and pathology. After this, she was referred to an oncologist for further management.Figure: Nodular gastritis.Discussion: Usually, gastric MALT lymphoma or MALTomas present with vague symptoms like abdominal pain, early satiety, nausea, vomiting, anorexia. Most commonly found in middle third of the stomach with ulceration being the most common finding on EGD. The main method of diagnosis is EGD with histopathology. H. pylori infection plays a pathogenic role and is seen in 90% of cases. Treatment for gastric maltoma patients should be chosen individually depending on the clinical stage of disease. Radiotherapy, chemotherapy, and/or surgery can be considered after unsuccessful eradication treatment as in our patient. Conclusion: As the presenting symptoms and EGD findings in MALToma are nonspecific, high degree of suspicion and confirmation with prompt biopsy is needed for early detection and improved prognosis.