Two Cases of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma With Helicobacter heilmannii Infection

Abstract

Helicobacter heilmannii (H. heilmannii)-associated gastric mucosa-associated lymphoid tissue (MALT) lymphoma have been reported, although rare. We describe here two cases of H. heilmannii-associated gastric MALT lymphoma. Case 1. A 50-year-old man presented with epigastralgia. Gastrointestinal endoscopy disclosed multiple gastric ulcerations in antrum. The endoscopic biopsy specimen suggested MALT lymphoma and bacteria were observed, which were larger and more tightly coiled than H. pylori. H. pylori was undetectable in histology and serum antibody test. He was treated with a 7-day course of triple therapy consisting of lansoprazole, amoxicillin, and clarithromycin. 2 months after eradication, CR was confirmed by endoscopic and histologic examinations. Four-years after eradication, there were no signs of MALT lymphoma recurrence on endoscopic finding and biopsy specimen. Case 2. A 43-year-old man visited our hospital for epigastralgia. Gastrointestinal endoscopy revealed multiple gastric ulcerations in the upper body and angle. The endoscopic biopsy specimen suggested MALT lymphoma. H. pylori was undetectable in a culture, urea breath test, H. pylori stool antigen test, and serum antibody test. H. heilmannii was positive by immunostaining and pseudo-positive by PCR. We performed eradication therapy with esomeprazole, amoxicillin, clarithromycin, and metronidazole for 7 days, and 2 months after the treatment, endoscopic gastrointestinal examination revealed that the multiple ulcer lesions had improved. Biopsy specimens demonstrated that the small lymphocytes had also decreased, but lymphoid nodules were present. Six months after eradication therapy, there were signs of MALT lymphoma recurrence on endoscopic finding and biopsy specimen. We performed radiation therapy, and CR was confirmed by endoscopic and histologic examinations. We presented two rare cases of H. heilmannii associated MALT lymphoma. Several reports described the effectiveness of eradication therapy for H. pylori-negative gastric MALT lymphoma. H. heilmannii infection may be closely associated with etiology of H. pylori-negative gastric MALT lymphoma.