MALT Lymphoma: A Dramatic Change Before and After Treatment of H. pylori

Abstract

Mucosa-associated lymphoid tissue (MALT) lymphoma is usually a low-grade neoplasia that is associated with Helicobacter pylori (H. pylori) infection. It accounts for 2-8% of all tumors of the stomach The clinical presentation of gastric MALT lymphoma is non-specific, and includes dyspepsia, epigastric pain, and less frequently, alarm symptoms, such as gastrointestinal bleeding or persistent vomiting. Here in, we present a 68 y/o male with a medical history of hypertension, dyslipidemia, chronic kidney disease (stage 3), osteoporosis, and anemia, who presented for evaluation of chronic epgiastric abdominal pain. Upper endoscopy showed a large ulcer just distal to the GE junction with raised edges and superficial necrosis (Figure 1A). Biopsy was consistent with MALT lymphoma and H. pylori. The patient was started on a 2 week course of proton pump inhibitor (PPI), clarithromycin, and amoxicillin. Eradication of H. pylori was confirmed by negative H. pylori stool antigen 4 weeks following completion of treatment regimen. After 8 months, repeat upper endoscopy demonstrated eradication of lymphoma (Figure 1B). Biopsies were negative for MALT lymphoma. While the frequency of MALT lymphoma is on the rise, it continues to be a rare clinical entity. Furthermore, though MALT lymphoma is a B-cell neoplasia, classic B symptoms are extremely rare. The treatment of MALT lymphoma targets H. pylori eradication as first line therapy where 75% of patients achieve remission. Data suggests that in H. pylori negative patients, H. pylori treatment has been successful in 15% of patients. For the management of patients who fail to achieve lymphoma remission following H. pylori eradication, alternative or second-line therapies include radiotherapy, chemotherapy and, in selected cases, surgery.Figure: Stomach MALT lymphoma before (A) and after (B) treatment.