Abstract
Most patients with gastric mucosa‐associated lymphoid tissue (MALT) lymphoma are infected with Helicobacter pylori, and eradication therapy is the first‐line treatment for localized disease with H pylori infection. However, there were several reports showing effectiveness of eradication therapy in even H pylori negative cases. Gastric MALT lymphomas are endoscopically classified into three common types: superficial, ulcerative, and elevated types. For the past 20 years, we have encountered 200 cases of localized gastric MALT lymphoma. Among them, only 4 cases (2%) showed similar macroscopic findings to those of nodular gastritis (gastric MALT lymphoma with nodular gastritis‐like appearance; M‐NGA). Here, we compared clinicopathological characteristics and prevalence of non‐H pylori Helicobacter (NHPH) infection between M‐NGA and other common types of gastric MALT lymphoma. To examine the prevalence of NHPH infection, DNA was extracted from formalin‐fixed paraffin‐embedded biopsy tissues from four cases of M‐NGA, 20 cases of common endoscopic types of gastric MALT lymphoma, and 10 cases of nodular gastritis. We used a highly sensitive polymerase chain reaction assay to detect the presence of five species of NHPH (Helicobacter suis, H felis, H bizzozeronii, H salomonis, and H heilmannii). H suis infection was detected in 4, 2, and 0 of the 4, 20, and 10 cases of M‐NGA, other types of gastric MALT lymphoma, and nodular gastritis, respectively. Other NHPH species were not detected in any cases. Complete response rate by eradication therapy was 4/4 in M‐NGA cases. Therefore, nodular gastritis‐like MALT lymphoma, which shows a very rare phenotype, is closely associated with NHPH infection, and eradication therapy may be the first‐choice treatment.
Highlights
Helicobacter pylori (H pylori) is a major cause of atrophic gastritis and is involved in the pathogenesis of several gastrointestinal diseases, including gastric ulcer, gastric adenocarcinoma, and gastric mucosa‐associated lymphoid tissue (MALT) lymphoma.[1]
We examined the prevalence of non‐H pylori Helicobacter (NHPH) infection and its association with macroscopic features of gastric MALT lymphoma
polymerase chain reaction (PCR) amplification of the urease gene from NHPH species (H suis, H bizzozeronii, H felis, H salomonis, and H heilmannii ss) was performed using species‐specific primers according to a previous report (Table 1).[17]
Summary
Helicobacter pylori (H pylori) is a major cause of atrophic gastritis and is involved in the pathogenesis of several gastrointestinal diseases, including gastric ulcer, gastric adenocarcinoma, and gastric mucosa‐associated lymphoid tissue (MALT) lymphoma.[1]. We examined the prevalence of NHPH infection and its association with macroscopic features of gastric MALT lymphoma. We macroscopically classified gastric MALT lymphoma into three types: superficial, elevated, and ulceration types (collectively referred to as the common type MALT lymphoma in this study). Of the 200 cases, 196 were common type MALT lymphoma, and the remaining four cases exhibited a distinctive appearance with a nodular elevation diffusely extending from the antrum to the corpus. This appearance is very similar to that of nodular gastritis. A second endoscopy was performed at 3‐12 months after completion of the antimicrobial treatment These studies were conducted in accordance with the Declaration of Helsinki
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