Korean J Gastroenterol.  2010 Aug;56(2):103-108. 10.4166/kjg.2010.56.2.103.

2 Cases of Gastric Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Submucosal Tumor-like Lesion

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. doc0224@pusan.ac.kr
  • 2Department of Pathology, Pusan National University School of Medicine, Busan, Korea.

Abstract

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is the most common form of primary extranodal lymphomas. In most cases, it is developed as multifocal and mucosal lesions, and its initial diagnosis is made by biopsy of suspicious lesions on endoscopy. However, when gastric MALT lymphoma afflict submucosal site without typical mucosal lesion, further procedures are necessary for diagnosis, such as endoscopic mucosal resection and endoscopic ultrasonography. We recently experienced two cases of submucosal tumor-like gastric MALT lymphoma. Both cases were without any mucosal lesion. One case was confirmed by endoscopic mucosal resection, and the latter was by wedge resection. Treatment modalities included endoscopic mucosal resection, surgery, H. pylori eradication, and/or chemotherapy. Both cases achieved complete remission until our 18 months' and 16 months' follow up.

Keyword

Lymphoma; Gastrointestinal neoplasms; Endosonography

MeSH Terms

Anti-Bacterial Agents/therapeutic use
Endosonography
Female
Gastric Mucosa/*pathology
Gastroscopy
Helicobacter Infections/drug therapy
Helicobacter pylori
Humans
Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/surgery
Male
Middle Aged
Stomach Neoplasms/diagnosis

Figure

  • Fig. 1. (A) Endoscopic findings. A prominently elevated submucosal tumor-like lesion covered with normal mucosa was seen on the posterior wall of lower body. (B) Endoscopic ultrasonographic finding. An about 1.1×0.6 cm, hypoechoic lesion with latticework structure was seen in the deep mucosal and superficial submucosal layer.

  • Fig. 2. (A) Endoscopic findings. The submucosal tumor-like lesion was resected by endoscopic mucosal resection after circumferential precutting. (B) Specimen of endoscopic mucosal resection.

  • Fig. 3. Histological findings. (A) Proliferated lymphoid tissue was mainly located in the submucosal layer (H&E, ×20). (B) Lymphoepithelial lesions which neoplastic lymphocytes invaded gastric glandular epithelium (H&E, ×200). (C) CD20 positive neoplastic cells infiltrated gastric glands, showing characteristic lymphoepithelial lesion (CD20, ×400). (D) Pancytokertin immunostain highlighted gastric glands which were destructed by infiltrating neoplastic lymphoid cells (cytokeratin, ×200).

  • Fig. 4. (A) Endoscopic finding. A buldging mass with intact over-lying mucosa was seen on the cardia. Several tiny erosions were seen on its top. (B) Endoscopic ultrasonographic finding. An about 1.6 ×1.4 cm hypoechoic lesion with suspicious latticework structure was seen in the submucosal layer.

  • Fig. 5. (A) Gross appearance of wedge resected specimen. The epicenter of the mass was in the submucosa. The cut surface of the mass was tan yellow and lobulated. (B) Neoplastic lymphoid cells infiltrated into the muscularis propria (H&E, ×40). (C) Neoplastic lymphoid cells showed small nuclei and clear cytoplasm and invaded gastric glands (H&E, ×200). (D) CD20 positive neoplastic cells diffusely effaced the submucosa and infiltrated into the mucosa (CD20, ×100).


Cited by  1 articles

Primary Mucosa-associated Lymphoid Tissue Lymphoma Metachronously Involving Esophagus and Stomach
Seung Joo Byun, Hyoun Woo Kang, Joo Kyoung Cha, Soo Ryeong Ryoo, Jeong Hyeon Lee, Do Yeon Kim, Eo Jin Kim
Korean J Gastroenterol. 2016;67(5):257-261.    doi: 10.4166/kjg.2016.67.5.257.


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