Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.
Highlights
Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma that mostly involves the stomach.[1,2] The clinical suspicion is virtually absent, based on the symptoms, and the diagnosis is often challenging because of the non-specificity of the conventional endoscopic findings.Patients with gastric MALT lymphoma can be asymptomatic or can present vague dyspeptic complaints
We present a case in which the ballooning crypt pattern (BCP) and an area with microstructure loss and tortuous vessels were observed on the initial endoscopic assessment of a middle-aged woman
A 41-year-old female patient, previously diagnosed with Sjögren syndrome, and with a family history of gastric adenocarcinoma, was submitted to an upper gastrointestinal (UGI) endoscopy for gastric cancer screening
Summary
MALT lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma that mostly involves the stomach.[1,2] The clinical suspicion is virtually absent, based on the symptoms, and the diagnosis is often challenging because of the non-specificity of the conventional endoscopic findings. Recent studies[4,13,14] endorsed the high sensitivity and specificity of these alterations and showed the usefulness of post-treatment endoscopic follow-up Another sign of gastric MALT lymphoma is crypt swelling, which is called “ballooning” (Figures 1A and 1B).[13] a Universidade de São Paulo (USP), Hospital Universitário, Endoscopy Service. No malignancy was detected on the first target biopsy specimens, the development of tree-like dilated vessels and an increase in the size of the area with a loss of microstructure was observed over a period of 2 years. With these new findings MALT lymphoma was confirmed by the histopathologic examination
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