Lymphoid Tissue Lymphoma Research Articles

A case of API2-MALT1-positive gastric MALT lymphoma with concomitant diffuse large B-cell lymphoma.

ABSTRACT API2-MALT1 translocation-positive gastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) lymphoma is thought to transform to diffuse large B-cell lymphoma (DLBCL) rarely. A 69-year-old man presented with epigastralgia. Esophagogastroduodenoscopy showed multiple ulcerations in the stomach. Endoscopic biopsies revealed MALT lymphoma, with Helicobacter pylori infection. The patient underwent eradication therapy with no improvement, and was thereafter followed without additional therapy at his request. Twelve years after initial diagnosis, follow-up computed tomography (CT) showed multiple nodules in bilateral lungs, and a needle biopsy revealed MALT lymphoma, the same as in the stomach and API2-MALT1 translocation was found. Because he again refused additional therapy, follow-up was continued. 15 years after initial diagnosis, CT showed lymphadenopathy at the splenic hilum. At first we suspected disease progression of gastric MALT lymphoma, however a needle biopsy revealed DLBCL without API2-MALT1. Thus, the tumor at the splenic hilum was finally diagnosed as a de novo DLBCL as a second malignancy. Although treatment with rituximab given his age and his wishes was attempted, he died of DLBCL 15 years after the initial diagnosis. We experienced an API2-MALT1-positive gastric MALT lymphoma with concomitant DLBCL, not transformed to DLBCL over a 15-year clinical course.

Primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue with multiple pure ground-glass opacities: a case report

BackgroundPrimary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B cell lymphoma that is a type of non-Hodgkin lymphoma and a type of primary pulmonary malignant lymphoma. MALT lymphomas affecting the lung show various findings on chest computed tomography, which range from typical nodules or areas of consolidation to findings that are extremely rare in pulmonary MALT lymphomas, such as pure ground-glass opacities throughout the lung.Case presentationA 35-year-old woman was found to have a few shadows with ground glass opacities on chest computed tomography (CT) in 2012. A shadow in right S10 that was initially very small increased in size over time, and was 14 × 8 mm in 2015. Other shadows also appeared. Because lung adenocarcinoma was suspected, the patient underwent video-assisted thoracoscopic surgery with a right wedge resection of the lower lobe that included the largest nodule in S10 and other nodules. Histopathological examination of the right S10 and other lesions revealed small- or medium-sized lymphocyte-like cells that were located in the alveolar interseptal spaces. The alveolar walls remained intact. Immunohistochemical staining showed that tumor cells were positive for CD20, CD79a, and BCL2 expression. The lesions were diagnosed as extranodal marginal zone B-cell lymphoma of MALT.ConclusionsWe think that the ground glass opacities on CT were accounted for by MALT lesions that contained intact alveolar air spaces. The patient has remained well during 12 months of follow up after surgery. Although she did not receive chemotherapy because the MALT lymphoma lesions have been stable without progression, the patient is kept under close observation because of potential progression of the disease.

Adult intussusception: An unlikely diagnosis

Intussusception happens when a portion of bowel telescopes into the adjacent bowel segment. It is a rare condition in the adult population, particularly in the young adult, and poses a diagnostic dilemma to the attending clinician because of its variable clinical presentation. Radiological imaging is important in the early diagnosis, and it allows prompt surgical management to avoid severe complications, particularly bowel ischaemia and necrosis. This case report describes the clinical and multimodality radiological findings of an ileocolic intussusception secondary to a mucosa-associated lymphoid tissue (MALT) lymphoma in a young adult patient.

DNA Double-Strand Breaks Caused by Different Microorganisms: A Special Focus on Helicobacter pylori.

The association between inflammation and cancer has long been recognized. Several studies have found that different types of tumors develop at sites of chronic inflammation. It is stated that over 15%-20% of malignancies worldwide can be related to infections caused by viruses, bacteria, and schistosomes. Inflammatory conditions are characterized by overexpression of inducible nitric oxide synthase (iNOS) and overproduction of nitric oxide/reactive nitrogen species (ROSs/RNSs) in epithelial cells. Reactive oxygen species (ROSs) may also lead to cellular alterations and eventually to inflammation. A variety of chronic infectious diseases can generate steady-state levels of ROSs/RNSs within infected cells and possibly lead to different types of DNA lesions. Accumulation of DNA lesions may finally lead to mutations that may activate oncogenes or inactivate tumor suppressor genes. Helicobacter pylori has been shown to generate ROSs/RNSs, induce DNA damage, and lead to chronic inflammation in gastric epithelial cells. A limited number of studies have addressed the effects of Helicobacter pylori on DNA damage, particularly its impact on single-strand and double-strand DNA breaks. This bacterium is classified as a Group I carcinogen by the International Agency for Research on Cancer on the basis of numerous animal and epidemiological studies. Chronic Helicobacter pylori infection can lead to increased risk of gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma. This review addresses the DNA-damaging and double-strand break-inducing effects of different microorganisms and their toxins, specifically focusing on Helicobacter pylori.

A CASE OF PERTUSSIS IN ADULT THAT COULD BE DIAGNOSED BY DETECTION OF BORDETELLA PERTUSSIS FROM SPUTUM

Bordetella pertussis isolation by culture has low detection sensitivity for diagnosing pertussis; the diagnosis is confirmed by measuring serum anti-pertussis toxin (anti-PT) or anti-filamentous hemagglutinin antibody titers, and by genetic testing (polymerase chain reaction/loop-mediated isothermal amplification). Isolation of B. pertussis in adults is difficult, resulting in a delayed diagnosis, as a delayed cough may present ≥3 months after onset. Differentiation from bronchial asthma is also important. We encountered an adult patient in whom B. pertussis was isolated by culture who previously received rituximab for mucosa-associated lymphoid tissue (MALT) lymphoma and steroids for prolonged cough. No elevation of anti-PT antibody titers was observed in the patient.

Primary Non-Hodgkin’s Orbital lymphoma of diffuse large B-cell type: a rare presentation

Primary Non-Hodgkin’s lymphoma of the orbit is a rare presentation and the diffuse large B-cell lymphoma (DLCL) type of histology is much less commoner than the mucosa associated lymphoid tissue (MALT) and follicular lymphoma. A 70 years female patient presented with palpable mass arising from right orbit and proptosis of the right eye. CT scan suggested homogenous enhancing soft tissue mass affecting right lacrimal region without any bony destruction. Biopsy confirmed it to be a case of Primary non-Hodgkin’s lymphoma of diffuse large B-cell type with strongly positive CD 20. She was given 6 cycles of chemotherapy with R-CHOP after surgery. The patient is now asymptomatic one year after the last cycle of the chemotherapy.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.624-627

Intestinal Microbiota and Lymphoma

The intestinal microbiota and gut immune system must constantly communicate to maintain a balance between tolerance and activation: on one hand, our immune system should protect us from pathogenic microbes and on the other hand, most of the millions of microbes in and on our body are innocuous symbionts and some can even be beneficial. Since there is such a close interaction between the immune system and the intestinal microbiota, it is not surprising that some lymphomas such as mucosal-associated lymphoid tissue (MALT) lymphoma have been shown to be caused by the presence of certain bacteria. Animal models played an important role in establishing causation and mechanism of bacteria-induced MALT lymphoma. In this review we discuss different ways that animal models have been applied to establish a link between the gut microbiota and lymphoma and how animal models have helped to elucidate mechanisms of microbiota-induced lymphoma. While there are not a plethora of studies demonstrating a connection between microbiota and lymphoma development, we believe that animal models are a system which can be exploited in the future to enhance our understanding of causation and improve prognosis and treatment of lymphoma.

Su1622 Asymptomatic Colonic Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Found Incidentally on Colonoscopy: A Case Series and Review of Treatment Guidelines

Su1622 Asymptomatic Colonic Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Found Incidentally on Colonoscopy: A Case Series and Review of Treatment Guidelines

Helicobacter Pylori Infection: Strains Virulence and Antibiotics Activity

Helicobacter pylori (Hp) was first isolated in culture media by Warren and Marshall in 1983. It is a Gram-negative, spiral-shaped bacterium, with positive findings for urease, oxidase and catalase. The bacterium colonizes the human gastric epithelium. Helicobacter pylori is the main cause of chronic active gastritis, peptic ulcer disease, gastric carcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Further, epidemiological and eradication studies have demonstrated a casual relationship between Helicobacter pylori infections and endothelial dysfunction, leading to vascular diseases [1]. Generally, the colonization occurs primarily during childhood especially in the developing areas, usually in the same family for a cohort effect. This colonization is widely asymptomatic even if a longlasting infection can be established in some subjects. Infection is virtually lifelong in the absence of treatment, implying that evasion of the host response is efficient [2].

Primary mucosa associated lymphoid tissue (MALT) B-cell lymphoma—a rare breast malignancy

Primary breast lymphoma (PBL) is an uncommon manifestation of breast cancer. Mucosa associated lymphoid tissue (MALT) lymphomas account for 12% of all PBLs, and most commonly present as a painless mass in the outer quadrant of the breast. They can also present with local pain or inflammation, palpable lymph nodes, and as incidental findings on screening mammography. We present a case of a breast mass found to be a PBL in an elderly woman.

Clinical analysis of 19 patients with primary pulmonary non-Hodgkin lymphoma

Objective To discuss the diagnosis, treatment and prognostic factors of primary pulmonary non-Hodgkin lymphoma (PPNHL). Methods A retrospective analysis was performed on the clinical data of 19 patients from January 2000 to October 2014, who was diagnosed as PPNHL in Henan Cancer Hospital with complete data. The Kaplan-Meier method and Log-rank test were used in the survival analysis and the difference analysis, respectively. Results There were 13 patients with primary pulmonary mucosa-associated lymphoid tissue (PPMALT) lymphoma in the group and the others were non-PPMALT lymphoma. The 5-year overall survival rate of the 19 patients was 72.3 %, among which patients with PPMALT lymphoma or non-PPMALT lymphoma had statistically significance (83.3 % vs 50.0 %, P= 0.047). Conclusions PPNHL is very rare, lacking specificity of its clinical manifestations and imaging findings. Pathology and immunohistochemistry are important to its diagnosis. Though PPNHL lacks uniform treatment programs, most of them are MALT lymphoma with good prognosis. Key words: Lymphoma, non-Hodgkin; Lung; Diagnosis; Therapy

Mucosa-associated lymphoid tissue (MALT) lymphoma of the small intestine

The following article describes the case of MALT lymphoma of the small intestine of a woman. The malignant tumors of the small intestine are rare diseases. Symptoms of MALT lymphoma are insignificant, so additional diagnosis methods are required.Aim. The goal of the research is to inform about special features of diagnostics and treatment of the given disease for the patient, treated with operation of small intestine resection followed by anti-helicobacter and cytostatic therapy.Methods and results. The kind of the tumor was identified after data of the histopathological and immunohistochemical stuudies had been received. Sternal punction conduction is necessary in order to exclude a leukemization and identification of the process stage.Conclusion. The given clinical case proves the necessity of the organ resection in order to identify the diagnosis of a rare localization of MALT lymphoma in the small intestine for its further correct treatment to improve the prognosis of the disease.

Unilateral submandibular swelling

A 60-year-old woman sought treatment at the Department of Oral Medicine at Peking University Hospital of Stomatology, Beijing, China. Her main symptom was a painless swelling of the left submandibular area that she had had for 2 months (Figure 1). Other symptoms included dry mouth and difficulty swallowing dry food. She did not complain of any other symptoms, such as fever, fatigue, reduced appetite, or weight loss. Dr. Lv is a PhD candidate, Department of Oral Medicine, Peking University Hospital of Stomatology, Beijing, China. Dr. Huang is a resident, Department of Oral Medicine, Peking University Hospital of Stomatology, Beijing, China. Dr. Yu is a professor, Department of Oral and Maxillofacial Surgery, Peking University Hospital of Stomatology, Beijing, China. Dr. Gao is a professor, Department of Oral Pathology, Peking University Hospital of Stomatology, No. 22, Zhongguancun South St., Haidian District, 100081, Beijing, China. A.Sjögren syndromeB.sarcoidosisC.sialosis (sialadenosis)D.immunoglobulin G4–related diseaseE.mucosa-associated lymphoid tissue lymphoma D.immunoglobulin G4–related disease

Diagnostic value of endoscopic ultrasonography combined with detection of immunoglobulin and T-cell receptor gene rearrangements in primary gastrointestinal lymphoma

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) combined with detection of immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements in primary gastrointestinal lymphoma (PGIL). Methods From 12nd January, 2012 to 23rd May, 2014, the clinical data of 24 patients with suspicious PGIL under endoscopy (regular biopsy negative and without treatment) and underwent further EUS examination was retrospectively analyzed. All patients received EUS-guided biopsy or EUS-guided fine needle aspiration (FNA) and the tissue specimens were detected for Ig and TCR gene rearrangements. Considering biopsy result, surgical pathological diagnosis and follow-up result as gold standard, the clinical significance of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of EUS combined with Ig/TCR gene rearrangements in PGIL were explored. Results Among 24 patients, 19 patients were finally diagnosed as PGIL, which were all non-Hodgkin's lymphoma (NHL); monoclonal gene rearrangement was found in 13 cases of the 19 cases. The left five cases were not lymphoma lesions (three cases of gastritis, one case of leather stomach and one case of malignant melanoma) with no monoclonal gene rearrangement. In cases diagnosed as PGIL, 14 were B cell NHL, which included eight cases of muscosa-associated lymphoid tissue (MALT) lymphoma and six cases of diffuse large B cell lymphoma. Of which, immunoglobulin heavy chain (IgH)/immunoglobulin kappa (IgK) gene rearrangement was found in 11 cases. A total of five cases were T cell NHL including one case of anaplastic large cell lymphoma, one case of NK/T cell lymphoma and three cases of enteropathy-associated T-cell lymphomas. TCR gene rearrangement was found in two cases. Because theoretically, there was no gene rearrangement in natural killer (NK)/T cell lymphoma, so NK/T cell lymphoma was excluded from statistical analysis. The sensitivity, specificity, PPV, NPV and accuracy of EUS combined with Ig/TCR gene rearrangements detection in PGIL were 72.2%, 100.0%, 100.0%, 50.0% and 78.3%, respectively. Conclusion The detection of monoclonal gene rearrangement in tissues from EUS-guided biopsy or EUS-guided FNA had better diagnostic value in PGIL, which improved the objectivity and accuracy of lymphoma diagnosis. Key words: Gastrointestinal neoplasms; Lymphoma; Gene rearrangement; Endoscopy

Retrospective Comparison of the Effectiveness of Various Treatment Modalities of Extragastric MALT Lymphoma: A single center analysis

We have performed a retrospective analysis of all patients with extragastric mucosa-associated lymphoid tissue (MALT) lymphoma treated at our institution to compare the efficacy of first-line therapeutic modalities including surgery, radiation, systemic therapy, and antibiotics. One hundred eighty-five patients with extragastric MALT lymphoma with a median age of 63 (interquartile range (IQR) 50-74) years and a median follow-up time of 49 (IQR 18-103) months were retrospectively analyzed. Time to progression and time to next therapy were used as surrogate endpoints for efficacy. Patients having either surgery (100 %), chemo/immunotherapy (85.5 %), or radiation (80 %) had significantly (p = 0.01) higher response rates than patients treated with antibiotics (33.3 %). Patients who were irradiated had significantly more progressive disease, but also the longest follow-up time. Stage, elevated LDH, anemia, elevated beta-2 microglobulin, plasmacytic differentiation, monoclonal gammopathy, or autoimmune disease did not influence the rate of disease progression nor did complete remission or partial remission from initial therapy influence time to and rate of progression. There was no significant difference in the median time to progression (p = 0.141), but the estimated time to progression (p = 0.023) as well as the estimated time to next therapy (p = 0.021) was significantly different among the various cohorts favoring surgery, chemo/immunotherapy, and radiation. Our results suggest extragastric MALT lymphoma as a potential systemic disease irrespective of initial stage. Radiation, surgery, and chemo/immunotherapy seem to be equally effective in achieving remissions and prolonged progression free survivals, but a curative potential is questionable. Localized MALT lymphomas affecting the thyroid gland or the lungs have excellent long-term progression-free survivals with surgical treatment only.

Central retinal vein occlusion caused by hyperviscosity syndrome in a young patient with Sjögren’s syndrome and MALT lymphoma

We report in this article central retinal vein occlusion (CRVO) caused by hyperviscosity syndrome (HVS) in a young patient with mucosa-associated lymphoid tissue (MALT) lymphoma and Sjögren's syndrome (SjS). A 32-year-old female was referred to our hospital from a local ophthalmologist. Fundoscopic examination and fluorescein angiogram revealed she had a serous retinal detachment in the right eye, together with CRVO (nonischemic type) in both eyes. Systemic examinations revealed hyperglobulinemia, increased blood viscosity, increased antinuclear antibody, increased rheumatoid arthritis particle aggregation, and increased anti-SS-A antibody. Together with a decreased salivary gland secretory function, she was eventually diagnosed as suffering from SjS. Moreover, a large cystic mass was found in the anterior mediastinum on the chest X-ray. Fine needle biopsy soon revealed she had MALT lymphoma. After eight courses of the administration of rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP), most laboratory values were normalized, including blood viscosity. Cystic mass in the anterior mediastinum decreased, and the conditions of CRVO in both eyes had much improved. Decreased best-corrected visual acuity (BCVA) in the right eye was fully restored by sixth month. Not only MALT lymphoma, but also SjS can cause secondary hyperglobulinemia. Indeed, immunoelectrophoresis-serum test showed a polyclonal pattern of hyperglobulinemia. Therefore, SjS was thought to be the primary reason of hyperglobulinemia in this patient, which induced HVS, eventually causing CRVO. R-CVP therapy was effective for not only MALT lymphoma but also SjS accompanied with HVS. Consequently, R-CVP therapy led to the improvement of CRVO.

Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma

Purpose: Mantle cell lymphoma (MCL) is known to have systemic dissemination with poor prognosis, but very few cases have been reported in Korea. Therefore, we analyzed clinical features and prognosis of MCL by comparing 3 cases of ocular adnexal MCL and mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: The medical records of patients with ocular adnexal MALT lymphoma and MCL from Chungnam National University Hospital and Pusan National University Hospital from January 1999 to April 2014 were retrospectively reviewed. Immunohistochemical examination was selectively used to diagnose lymphoma subtypes. Systemic dissemination, treatment response, and recurrence were identified using radiological testing and bone marrow aspiration. Results: This study included 39 patients with ocular and ocular adnexal MALT lymphoma and 1 patient with MCL from Chungnam National University Hospital and 53 patients with MALT lymphoma and 2 patients with MCL from Pusan National University Hospital. All 3 (100%) patients diagnosed with ocular adnexal MCL were over 60 years of age. However, 28 of 92 (30.4%) patients diagnosed with MALT lymphoma were over 60 years of age. In MALT lymphoma, 3 of 92 patients presented with systemic dissemination and most patients recovered with radiotherapy. Conversely, all 3 patients with MCL showed systemic dissemination and recurrence after radiotherapy or chemotherapy, therefore, additional chemotherapy was required. Conclusions: Contrary to MALT lymphoma, ocular and ocular adnexal MCL usually presented with systemic dissemination and complete remission was difficult even though many regimens of chemotherapy were attempted. Because MCL can be misdiagnosed as MALT lymphoma, careful evaluation should be performed. J Korean Ophthalmol Soc 2015;56(6):815-822

Primary Pulmonary MALT Lymphoma about Four Cases and Literature Review

Bronchial-associated lymphoid tissue (BALT) lymphoma is a distinct subgroup of low-grade B-cell extranodal non- Hodgkin’s lymphoma, classified as marginal-zone lymphoma. This study was performed in order to assess the natural history of this rare entity. We evaluated retrospectively the clinical, radiological and histological features and to discuss the optimal management and prognostic factors through a literature review, of 4 patients with biopsy-proven BALT lymphoma collected at department of pathology of Erasme from 2010 to 2014. The group of four patients included tree women and one man, with a median age of 69 years (Range: 45-84 years). One of 4 patients presented fever chest pain within bronchopneumonia, other patients were asymptomatic with an incidental finding after preoperative radiological assessment. Computed tomography (CT), which is more sensitive than standard radiography, has demonstrated that the lesions are unilateral (n=3) and multiple (1 patient), without lymph node enlargement. All of our patients has a thoracoscopy diagnosis and therapeutic. Macroscopy: whitish lesions poorly defined. Microscopy: MALT lymphoma low grade (CD20 +, bcl2+). All of our patients have just a local treatment without chemotherapy and three were alive after a follow extended.

11. A case of extranodal marginal zone lyphoma of mucosa-associated lymphoid tissue (MALT) type and hepatocellular carcinoma

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease. MALT lymphoma is a type of low grade extranodal B-cell lymphoma which is commonly diagnosed in the stomach where there is a well-documented association with Helicobacter pylori infection. In reported cases of primary liver MALT, it is often an incidental finding during imaging or surgery for other disease and patients usually do not have symptoms specifically related to the lymphoma. The information available from reported cases of primary liver MALT lymphoma have included associated inflammatory diseases of the liver including hepatitis B or hepatitis C (either with or without cirrhosis) or primary biliary cirrhosis. This supports the role of chronic inflammation in the pathogenesis of the condition regardless of primary site. As primary hepatic MALT lymphoma is usually asymptomatic it is likely to be an under-reported diagnosis. Only one case of concurrent hepatocellular carcinoma with hepatic MALT lymphoma on a background of hepatitis B infection is reported in the literature. We present a case of a 62 year old patient who presented with non-cirrhotic hepatocellular carcinoma on a background of cleared chronic hepatitis B infection. The patient has positive hepatitis B core antibody with negative hepatitis B surface antigen. The right hepatectomy specimen showed moderately differentiated hepatocellular carcinoma as well as an incidental diagnosis of extranodal marginal zone lymphoma of MALT type and the gallbladder specimen also showed involvement. We present this additional case of concurrent hepatocellular carcinoma and hepatic MALT lymphoma to bring to attention this extremely rare entity.

Complete Histopathological Disappearance of Rectal Malt Lymphoma after Eradication of Helicobacter pylori Confirmed by ESD

In a 77-year-old Japanese housewife who was undergoing regular colonoscopy for follow-up of a colon polyp, a total colonoscopy showed an elevated lesion in the rectum. Histological findings of a conventional biopsy from the lesion showed a mucosa-associated lymphoid tissue (MALT) lymphoma, and the patient was diagnosed as having clinical stage 1 disease. We elected to administer antibiotic therapy as the serological test for anti-Helicobacter pylori antibody was positive and Helicobacter pylori was detected in a culture of the biopsy specimens. The antibiotic therapy was successful, however, colonoscopy after the eradication therapy showed a residual lesion. Histologic examination can’t deny the possibility of the presence of a residual MALT lymphoma. Endoscopic ultrasonography revealed that the lesion was confined to the mucosa. We performed endoscopic submucosal dissection (ESD) and histological examination of the ESD specimen showed complete disappearance of the tumor. The patient remains in complete remission now, 1 year after the treatment.