Related Subjects:
|Hodgkin Lymphoma
|Non Hodgkin Lymphoma
|Diffuse large B-cell lymphoma
|Intravascular large B-cell lymphoma
|Mantle cell lymphoma
|Marginal Zone Lymphoma
|Gastric (MALT) Lymphoma
|Primary CNS Lymphoma (PCNSL)
|Burkitt's lymphoma
|Follicular Lymphoma
Better prognosis than gastric adenocarcinomas. Gastric MALT lymphoma (Mucosa-Associated Lymphoid Tissue lymphoma) is a type of non-Hodgkin lymphoma that originates from the lymphoid tissue in the stomach lining. It is often associated with chronic Helicobacter pylori infection, which stimulates the growth of lymphoid tissue in the stomach, potentially leading to malignancy. MALT lymphoma is usually indolent, meaning it progresses slowly.
About
- Commonest extra nodal site for Non-Hodgkin's lymphoma
- Primary gastric lymphomas also seen
- B-cell MALT lymphomas associated with H.pylori infection
Pathology
- Slow growing non-Hodgkin lymphoma
- Distal stomach, Gastritis or benign ulcer-like appearance
- High risk of progression: H. pylori-negative at initial presentation or t(11:18) translocation
Clinical
- Abdominal Pain: Often the most common symptom, typically located in the upper abdomen.
- Nausea and Vomiting: Common gastrointestinal symptoms associated with the disease.
- Dyspepsia: Indigestion, heartburn, and bloating.
- Unintended Weight Loss: Weight loss without a clear cause may occur in some patients.
- Fatigue: General tiredness and weakness.
- Occult Gastrointestinal Bleeding: May lead to anaemia, often detected through low haemoglobin levels or positive fecal occult blood tests.
Investigations
- FBC, U&E, LFT, Ca, P, ALP, LDH, ESR
- Endoscopy - conventional white light endoscopy, the mucosal
alterations can mimic gastric lesions of different entities,
such as gastritis, peptic ulcer, polyps, early or advanced
gastric cancer, and subepithelial lesions
- Biopsy positive tissue diagnosis in 80%
Management
- H. pylori Eradication Therapy: The first-line treatment for H. pylori-positive gastric MALT lymphoma is antibiotic therapy combined with proton pump inhibitors (PPIs) to eradicate the infection. In many cases, the lymphoma regresses completely after successful eradication of H. pylori.
- Radiation Therapy: For localized disease not responding to H. pylori eradication or in H. pylori-negative cases, radiation therapy may be used.
- Chemotherapy: Systemic chaemotherapy may be required for advanced or refractory cases, especially if the lymphoma has spread beyond the stomach.
- Monoclonal Antibody Therapy: Rituximab, an anti-CD20 monoclonal antibody, is sometimes used in combination with chaemotherapy or as a single agent.
- Surgery: Rarely needed today but may be considered in cases where there is a risk of perforation or severe bleeding.
Prevention
- H. pylori Screening and Treatment: Early detection and treatment of H. pylori infection in high-risk populations can reduce the risk of developing gastric MALT lymphoma.
- Management of Autoimmune Conditions: Regular monitoring and management of autoimmune diseases can help reduce the associated risk.