Treatment of low-grade gastric MALT lymphoma using Helicobacter pylori eradication

Saša Grgov; Vuka Katić; Miljan Krstić; Aleksandar Nagorni; Biljana Radovanović - Dinić; Tomislav Tasić

doi:10.2298/4555

Saša Grgov Department of Gastroenterology and Hepatology, General Hospital Leskovac, Leskovac, Serbia
Vuka Katić Polyclinic Human, Niš, Serbia
Miljan Krstić Institut of Pathology, Faculty of Medicine Niš, University of Niš, Serbia
Aleksandar Nagorni Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia
Biljana Radovanović - Dinić Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia
Tomislav Tasić Department of Gastroenterology and Hepatology, General Hospital Leskovac, Leskovac, Serbia

DOI: https://doi.org/10.2298/4555

Keywords: lymphoma, b-cell, marginal zone, stomach neoplasms, helicobacter pylori, drug therapy, remission induction, prognosis, histology,

Abstract

Background/Aim. Lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach usually occurs as a consequence of Helicobacter pylori (H. pylori) infection. The aim of this study was to investigate the long-term effect of treatment of low-grade gastric MALT lymphoma with the H. pylori eradication method. Methods. In the period 2002–2012 in 20 patients with dyspepsia, mean age 55.1 years, the endoscopic and histologic diagnosis of gastric MALT lymphoma in the early stages were made. Histological preparations of endoscopic biopsy specimens were stained with hematoxyllin-eosin (HE), histochemical and immunohistochemical methods. Results. Endoscopic findings of gastritis were documented in 25% of the patients, and 75% of the patients had hypertrophic folds, severe mucosal hyperemia, fragility, nodularity, exulcerations and rigidity. Histopathologically, pathognomonic diagnostic criterion were infiltration and destruction of glandular epithelium with neoplastic lymphoid cells, the so-called lymphoepithelial lesions. In all 20 patients H. pylori was verified by rapid urease test and Giemsa stain. After the triple eradication therapy complete remission of MALT lymphoma was achieved in 85% of the patients, with no recurrence of lymphoma and H. pylori infection in the average follow-up period of 48 months. In 3 (15%) of the patients, there was no remission of MALT lymphoma 12 months after the eradication therapy. Of these 3 patients 2 had progression of MALT lymphoma to diffuse large-cell lymphoma. Conclusion. Durable complete remission of low-grade gastric MALT lymphoma is achieved in a high percentage after eradication of H. pylori infection, thus preventing the formation of diffuse large-cell lymphoma and gastric adenocarcinoma.

Author Biographies

Saša Grgov, Department of Gastroenterology and Hepatology, General Hospital Leskovac, Leskovac, Serbia

Research associate

Chef of Department of Internal medicine

General hospital Leskovac

Vuka Katić, Polyclinic Human, Niš, Serbia

Emeritus professor

Polyclinic Human, Nis

Miljan Krstić, Institut of Pathology, Faculty of Medicine Niš, University of Niš, Serbia

Doc.dr , School of Medicine , University of NIs.

Aleksandar Nagorni, Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia

Prof.dr, School of Medicine, University of NIs.

Biljana Radovanović - Dinić, Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia

Doc.dr School of Medicine, University of NIs.

Tomislav Tasić, Department of Gastroenterology and Hepatology, General Hospital Leskovac, Leskovac, Serbia

Shef of Clinical section for gastroenterology and hepatology, Specialist internist gastroenterologist.

References

Farinha P, Gascoyne RD. Helicobacter pylori and MALT lym-phoma. Gastroenterology 2005; 128(6): 1579−605.

Zullo A, Hassan C, Cristofari F, Perri F, Morini S. Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helico-bacter pylori and beyond. World J Gastrointest Oncol 2010; 2(4): 181−6.

Morris GJ, Dotan E, Smith MR, Hagemeister FB, Brereton HD. Gastric mucosa-associated lymphoid tissue lymphoma. Semin Oncol 2010; 37(3): 183−7.

Sagaert X, Van Cutsem E, De Hertogh G, Geboes K, Tousseyn T. Gastric MALT lymphoma: A model of chronic inflammation-induced tumor development. Nat Rev Gastroenterol Hepatol 2010; 7(6): 336−46.

Isaacson PG. Update on MALT lymphomas. Best Pract Res Clin Haematol 2005; 18(1): 57−68.

Wotherspoon AC, Dogan A, Du M. Mucosa-associated lymphoid tissue lymphoma. Curr Opin Hematol 2002; 9(1): 50−5.

Yakoob MY, Hussainy AS. Chronic gastritis and Helicobacter pylori: A histopathological study of gastric mucosal biopsies. J Coll Physicians Surg Pak 2010; 20(11): 773−5.

Wotherspoon AC, Ortiz-Hidalgo C, Falzon MR, Isaacson PG. Heli-cobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 1991; 338(8776): 1175−6.

Genta RM, Graham DY. Primary gastric MALT lymphoma: Trivial condition or serious disease. Helicobacter 1997; 2(Suppl 1): S56−60.

Katić VV, Nagorni AV, Pashalina M, Katić K, Grgov SR, Zlatić A, et al. Morphological features of malt lymphoma of the sto-mach before and after the eradication therapy. Acta Facult Med Naiss 2003; 20(1): 65−9. (Serbian)

Doglioni C, Ponzoni M, Ferreri AJ, Savio A. Gruppo Italiano Pa-tologi Apparato Digerente (GIPAD); Società Italiana di Ana-tomia Patologica e Citopatologia Diagnostica/International Academy of Pathology, Italian division (SIAPEC/IAP).Gastric lymphoma: The histology report. Dig Liver Dis 2011; 43(Suppl 4): S310−8.

Fischbach W. Gastric mucosa-associated lymphoid tissue lym-phoma: A challenge for endoscopy. Gastrointest Endosc 2008; 68(4): 632−4.

Ahmad A, Govil Y, Frank BB. Gastric mucosa-associated lym-phoid tissue lymphoma. Am J Gastroenterol 2003; 98(5): 975−86.

Siddiqui ST, Naz E, Danish F, Mirza T, Aziz S, Ali A. Frequency of Helicobacter pylori in biopsy proven gastritis and its as-sociation with lymphoid follicle formation. J Pak Med Assoc 2011; 61(2): 138−41.

Asenjo LM, Gisbert JP. Prevalence of Helicobacter pylori infec-tion in gastric MALT lymphoma: A systematic review. Rev Esp Enferm Dig 2007; 99(7): 398−404.

Grgov SR, Stefanović M, Katić VV. The relationship between the density of Helicobacter pylori colonisation and the degree of gastritis severity. Arch Gastroenterohepatol 2002; 21(3−4): 66−72.

Grgov SR. Helicobacter pylori infection: pathogenesis and clini-cal consequences. Leskovac: Naša reč; 2002. (Serbian)

Malfertheiner P, Megraud F, Morain CO, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection: The Maastricht IV/Florence Consensus Report. Gut 2012; 61(5): 646−64.

Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther 2011; 34(9): 1047−62.

Hong SS, Jung H, Choi KD, Song HJ, Lee GH, Oh TH, et al. A prospective analysis of low-grade gastric malt lymphoma after Helicobacter pylori eradication. Helicobacter 2006; 11(6): 569−73.

Zullo A, Hassan C, Cristofari F, Andriani A, De Francesco V, Ierardi E, et al. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol 2010; 8(2): 105−10.

Nakamura S, Matsumoto T, Suekane H, Nakamura S, Matsumoto H, Esaki M, et al. Long-term clinical outcome of Helicobacter pylori eradication for gastric mucosa-associated lymphoid tis-sue lymphoma with a reference to second-line treatment. Can-cer 2005; 104(3): 532−40.

Montalban C, Norman F. Treatment of gastric mucosa-associated lymphoid tissue lymphoma: Helicobacter pylori era-dication and beyond. Expert Rev Anticancer Ther 2006; 6(3): 361−71.

Thiede C, Wündisch T, Alpen B, Neubauer B, Morgner A, Schmitz M, et al. Long-term persistence of monoclonal B cells after cure of Helicobacter pylori infection and complete histologic remission in gastric mucosa-associated lymphoid tissue B-cell lymphoma. J Clin Oncol 2001; 19(6): 1600−9.

Capelle LG, de Vries AC, Looman CW, Casparie MK, Boot H, Meijer GA, et al. Gastric MALT lymphoma: Epidemiology and high adenocarcinoma risk in a nation-wide study. Eur J Cancer 2008; 44(16): 2470−6.