Abstract
Helicobacter pylori-related extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue is a paradigm for malignancy arising in an inflammatory background. While the diagnosis of H. pylori gastritis is often straightforward, distinction between severe gastritis and early lymphoma can be difficult and requires careful assessment of clinical findings in addition to histological features and immunohistochemical results. A number of cytogenetic abnormalities have been discovered in H. pylori-related lymphomas and several have clinical importance, related to the responsiveness of lymphoma to H. pylori eradication therapy, but routine molecular studies are not widely utilized. While molecular methods may be used in equivocal cases, a trial of conservative therapy is warranted given the propensity for these lymphomas to regress with eradication of the organism. Once therapy is initiated, care must be taken to avoid a premature assignment of disease refractoriness because complete response can take several months to more than a year. Cases truly refractory to H. pylori eradication therapy may be treated with adjuvant chemoradiation with a high response rate.
Highlights
Helicobacter pylori is a common pathogen and the most frequent cause of gastric and duodenal ulcers (Figure 1) [1, 2]
Most H. pylori-related MALT lymphomas arise in the stomach, but extragastric lymphomas may be related to the organism, in the duodenum [7]
This paper summarizes the current knowledge of cytogenetic abnormalities in GI MALT lymphoma, with particular attention to H. pylori-related gastric lymphomas
Summary
Helicobacter pylori is a common pathogen and the most frequent cause of gastric and duodenal ulcers (Figure 1) [1, 2] This Gram-negative, curved bacillus was first recognized as the cause of human disease by Marshall and Warren in the 1980s and has since been classified as a class I carcinogen, potentially leading to gastric adenocarcinoma and, more commonly, extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) [2,3,4,5,6]. While molecular assays for these abnormalities are available, guidelines for their routine use are not widely accepted, and the vast majority of cases of gastric as well as many extragastric, MALT lymphomas respond to conservative therapy aimed at eradication of infection [8, 12,13,14,15,16,17]. Recommendations for disease followup are offered, with an emphasis on the utility of conservative therapy and avoidance of a premature determination of refractoriness to H. pylori eradication therapy
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