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Vlăduţ C, Ciocîrlan M, Costache RS, Jinga M, Balaban VD, Costache DO, Diculescu M. Is mucosa-associated lymphoid tissue lymphoma an infectious disease? Role of Helicobacter pylori and eradication antibiotic therapy (Review). Exp Ther Med 2020; 20:3546-3553. [PMID: 32905014 DOI: 10.3892/etm.2020.9031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022] Open
Abstract
Mucosa-associated lymphoid tissue lymphoma (MALT) is seldom considered a diagnosis hypothesis in symptomatic patients. These lymphomas present as a main risk factor for chronic gastritis due to Helicobacter pylori infection. H. pylori leads to chronic inflammation, producing lymphoid tissue in the stomach mucosa (MALT) possibly leading to malignant transformation. Even though H. pylori remains one of the most important factors in the development of MALT lymphoma, it is not mandatory in the evolution of MALT lymphoma since high-grade lymphomas present a lower prevalence of H. pylori. The prevalence of H. pylori is indirectly proportional with the progression into the gastric wall. Mucosal and submucosal MALT lymphomas have a higher prevalence of the bacteria. However, genetic factors remain a risk factor especially if eradication treatment fails. Even though a low percentage of MALT lymphomas are H. pylori-negative, some respond to antibiotic eradication treatment. This can be explained either by the immunomodulatory effect of antibiotics or by other infectious sources such as Helicobacter heilmannii and Campylobacter jejuni (small bowel lymphoma). Treatment in MALT gastric lymphoma was a breakthrough since it was the first time in oncology where tumours were cured by antibiotic therapy, leading us to wonder if MALT lymphomas are infectious disease or not?
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Affiliation(s)
- Cătălina Vlăduţ
- Department of Gastroenterology, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania.,The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihai Ciocîrlan
- Department of Gastroenterology, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania.,The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Raluca S Costache
- The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Gastroenterology, 'Carol Davila' University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Mariana Jinga
- The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Gastroenterology, 'Carol Davila' University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Vasile D Balaban
- The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Gastroenterology, 'Carol Davila' University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Daniel O Costache
- Department of Research, 'Carol Davila' University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Mircea Diculescu
- The Fifth Clinical Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Gastroenterology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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2
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Chang JS, Kuo SH, Chu PY, Shan YS, Tsai CR, Tsai HJ, Chen LT. The Epidemiology of Gastric Cancers in the Era of Helicobacter pylori Eradication: A Nationwide Cancer Registry-Based Study in Taiwan. Cancer Epidemiol Biomarkers Prev 2019; 28:1694-1703. [PMID: 31350264 DOI: 10.1158/1055-9965.epi-19-0355] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/31/2019] [Accepted: 07/22/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Helicobacter pylori eradication has been shown to decrease gastric adenocarcinoma risk. The epidemiology of gastric lymphoma, which is also associated with H. pylori, and other rare subtypes of gastric cancer is less clear. This study comprehensively evaluated the incidence trend and the survival of gastric cancer in Taiwan by histologic subtype. METHODS The incidence trends of gastric cancer in Taiwan from 1996 and 2013 were evaluated using data from the Taiwan Cancer Registry. The life-table method and the Cox proportional hazards analysis were used to evaluate the survival of gastric cancer. RESULTS The incidence of all gastric cancers in Taiwan decreased from 15.97 per 100,000 in 1996 to 11.57 per 100,000 in 2013. The most frequent histologic subtype of gastric cancer in Taiwan was adenocarcinoma, followed by lymphoma and sarcoma (mainly gastrointestinal stromal tumor). The best survival was in patients with sarcoma, followed by lymphoma, neuroendocrine tumor, and adenocarcinoma. Generally, women had a better survival than men. The incidence of adenocarcinoma significantly decreased from 13.56 per 100,000 in 1996 to 9.82 per 100,000 in 2013 (P < 0.0001). In contrast, the incidences of mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma did not decrease. CONCLUSIONS The incidence of adenocarcinoma and lymphoma, both of which are associated with H. pylori, showed diverging trends. The survival of gastric cancer differed by histologic subtype and sex. IMPACT The disparity in the incidence trends between gastric lymphoma and adenocarcinoma, both associated with H. pylori, warranted the need to search for additional risk factors of gastric lymphoma.
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Affiliation(s)
- Jeffrey S Chang
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Yi Chu
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Pathology, Show Chwan Memorial Hospital, Changhua, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yan-Shen Shan
- Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Rung Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Hui-Jen Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan. .,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Institute of Molecular Medicine, National Cheng Kung University, Tainan, Taiwan
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3
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Park SH, Lee JJ, Kim HO, Lee DY, Suh C, Jung HY, Choi KD, Kim DH, Huh J, Ryu JS. 18F-Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography in mucosa-associated lymphoid tissue lymphoma: variation in 18F-FDG avidity according to site involvement. Leuk Lymphoma 2015; 56:3288-94. [PMID: 25804932 DOI: 10.3109/10428194.2015.1030640] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the 18F-FDG avidity of MALT lymphoma and the additional utility of 18F-FDG PET/CT in MALT lymphoma staging. Pretreatment 18F-FDG PET/CT scans of 222 patients with 227 MALT lymphoma lesions were retrospectively analyzed. 18F-FDG avidity of lesions was noted in 28%. The proportion was lower for gastric MALT lymphomas than for non-gastric lesions (9% vs. 60%, p<0.0001) and higher for mass-forming lesions than for superficial lesions (82% vs. 2%, p<0.0001). 18F-FDG PET/CT showed the presence of additional lesions in 23 patients: four of six true-positive lesions had 18F-FDG avid primary lesions, and 15 of 17 false-positive lesions had 18F-FDG-non avid lesions. 18F-FDG avidity differed according to the location and gross morphologic characteristics of the MALT lymphoma. Most gastric MALT lymphomas were superficial and had low 18F-FDG avidity. For staging, 18F-FDG PET/CT can be helpful mainly for 18F-FDG avid primary MALT lymphomas.
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Affiliation(s)
- Seol Hoon Park
- a Department of Nuclear Medicine , Ulsan University Hospital , Seoul , Republic of Korea
| | - Jong Jin Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hye Ok Kim
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Dong Yun Lee
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Cheolwon Suh
- c Department of Internal Medicine and Oncology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Hwoon-Yong Jung
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Kee Don Choi
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Do Hoon Kim
- d Department of Internal Medicine and Gastroenterology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jooryung Huh
- e Department of Pathology , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jin-Sook Ryu
- b Department of Nuclear Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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4
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The Influence of the Gut Microbiome on Obesity, Metabolic Syndrome and Gastrointestinal Disease. Clin Transl Gastroenterol 2015; 6:e91. [PMID: 26087059 PMCID: PMC4816244 DOI: 10.1038/ctg.2015.16] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
There is a fine balance in the mutual relationship between the intestinal microbiota and its mammalian host. It is thought that disruptions in this fine balance contribute/account for the pathogenesis of many diseases. Recently, the significance of the relationship between gut microbiota and its mammalian host in the pathogenesis of obesity and the metabolic syndrome has been demonstrated. Emerging data has linked intestinal dysbiosis to several gastrointestinal diseases including inflammatory bowel disease, irritable bowel syndrome, nonalcoholic fatty liver disease, and gastrointestinal malignancy. This article is intended to review the role of gut microbiota maintenance/alterations of gut microbiota as a significant factor as a significant factor discriminating between health and common diseases. Based on current available data, the role of microbial manipulation in disease management remains to be further defined and a focus for further clinical investigation.
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5
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Adam P, Czapiewski P, Colak S, Kosmidis P, Tousseyn T, Sagaert X, Boudova L, Okoń K, Morresi-Hauf A, Agostinelli C, Pileri S, Pruneri G, Martinelli G, Du MQ, Fend F. Prevalence ofAchromobacter xylosoxidansin pulmonary mucosa-associated lymphoid tissue lymphoma in different regions of Europe. Br J Haematol 2013; 164:804-10. [DOI: 10.1111/bjh.12703] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/01/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick Adam
- Institute of Pathology; University of Tübingen; Tübingen Germany
| | - Piotr Czapiewski
- Department of Pathomorphology; Medical University of Gdansk; Gdansk Poland
| | - Seba Colak
- Institute of Pathology; University of Tübingen; Tübingen Germany
| | | | - Thomas Tousseyn
- KU Leuven; Translational Cell and Tissue Research; Leuven Belgium
| | - Xavier Sagaert
- KU Leuven; Translational Cell and Tissue Research; Leuven Belgium
| | - Ludmila Boudova
- Department of Pathology; Medical Faculty Hospital; Charles University of Plzen; Plzen Czech Republic
| | - Krzysztof Okoń
- Institute of Pathology; Jagiellonian University Kraków; Krakow Poland
| | - Alicia Morresi-Hauf
- Institute of Pathology; Centre of Pneumology and CTC Surgery; Asklepios Hospital; Gauting Germany
| | - Claudio Agostinelli
- Unità Operativa di Emolinfopatologia; Università degli Studi di Bologna; Bologna Italy
| | - Stefano Pileri
- Unità Operativa di Emolinfopatologia; Università degli Studi di Bologna; Bologna Italy
| | | | | | - Ming-Qing Du
- Division of Molecular Histopathology; Department of Pathology; University of Cambridge; Cambridge UK
| | - Falko Fend
- Institute of Pathology; University of Tübingen; Tübingen Germany
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6
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Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther 2011; 34:1047-62. [PMID: 21919927 DOI: 10.1111/j.1365-2036.2011.04839.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori infection is the main cause of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. AIM To review several common misconceptions in the management of H. pylori-associated gastric MALT-lymphoma. METHODS Bibliographical searches were performed in MEDLINE up to June 2011. RESULTS If adequate diagnostic methods are used, and if only low-grade lymphomas are considered, the prevalence of H. pylori infection is very high (almost 90%). H. pylori eradication is effective in treating approximately 80% of patients with early stage lymphoma. In H. pylori-positive gastric high-grade lymphomas, antibiotic therapy should always be prescribed, as approximately 50% of them regress after H. pylori eradication. Patients with early stage MALT lymphoma negative for H. pylori might still benefit from antibiotic treatment as the sole treatment. Complete remission of gastric MALT lymphoma after H. pylori eradication can take even >12 months. PCR assay for the detection of monoclonal B cells remains positive in many cases after complete remission has been reached. Patients with a persistent clonal band should not be treated unless the lymphoma can be histologically demonstrated. Synchronous occurrence of gastric adenocarcinoma and MALT lymphoma has been repeatedly reported. In some patients in complete remission, eradication of H. pylori does not prevent later development of early gastric cancer. Gastric lymphoma recurrence occurs in some patients after both bacterial and lymphoma regression. H. pylori reinfection does not constitute a prerequisite for lymphoma recurrence. CONCLUSIONS The present article states several misconceptions in the management of H. pylori-associated gastric MALT-lymphoma in clinical practice, reviews the related scientific evidence and proposes the adequate attitude in each case.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
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7
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[Primary digestive tract lymphoma in central region of Tunisia: anatomoclinical study and therapeutic results about 153 cases]. Bull Cancer 2010; 97:435-43. [PMID: 20395189 DOI: 10.1684/bdc.2010.1085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Primary gastro-intestinal lymphoma (PGIL) is the most common type of extra-nodal non Hodgkin's lymphoma. Their clinical and histological presentations are heterogeneous depending on the site of the lesion. There is no consensus regarding the role of surgery and chemotherapy in the therapeutic approach. In our country epidemiology of the disease is unknown with IPSID being the most frequent type. We report anatomo-clinical features and prognostic factors of PGIL and compare intestinal to gastric forms in our region. This is a retrospective study of 153 cases of PGIL in adults diagnosed and treated in the department of medical oncology in Farhat Hached Hospital between 1994 and 2006. The median age was 52 years and the sex-ratio 2.1. Tumor sites were gastric (67%), intestinal (26%) and gastrointestinal (7%). Abdominal pain (87%) followed by vomiting and diarrhoea (37 and 15%) were the most common symptoms. Performance status (PS) < 2 was seen in 80% of patients, high grade lymphoma in 70.5% of cases and B phenotype was noted in 85%. MALT lymphoma accounts for 50% of cases, and IPSID for only 5% of PGIL. About 47.5% of cases were stage IE, 138 patients had chemotherapy with an objective response rate of 77%. Only 46% of patients had surgery (14 for surgical complication, 6 for residual tumor after chemotherapy and 22 to have histological diagnosis). The five-year overall survival (OS) was 62%. In high grade lymphoma patients favorable prognostic factors for OS included young age < or = 60 years, PS < 2, normal serum LDH, hemoglobin > 12 g/dL, B phenotype, localised stage (IE-IIE1), anthracycline-based chemotherapy regimen, achieving complete or partial response to induction chemotherapy and no relapse. In multivariate study only relapse and PS were significant prognostic factors for OS. In low-grade lymphoma patients, none of these factors had a significant correlation with OS: age < or = 60 years, PS < 2, stage (IE-IIE1), response to induction chemotherapy, relapse. Compared to gastric lymphomas, intestinal cases occurred at a younger age, frequently with diarrhoea, weight loss, and occlusion. They are more often high-grade, T phenotype and have locally advanced stage (IIE); surgery is more common in this group. We conclude that stomach is the main site of PGIL in our region, intestinal lymphoma is less frequent and IPSID has become rare. Recent progress in chemotherapy has allowed good therapeutic results with a conservative approach. Surgery may be performed in case of emergency or for residual lesions after medical treatment.
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8
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Wang XIN, WillÉN ROGER, Andersson CHRISTINA, WadstrÖM TORKEL. Development of high-grade lymphoma in Helicobacter pylori-infected C57BL/6 mice. APMIS 2008. [DOI: 10.1034/j.1600-0463.2000.01087-8503.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Abstract
Mycosis fungoides and Sézary syndrome are the most common of the cutaneous T-cell lymphomas, which are a heterogeneous group of neoplasms that affect the skin as a primary site. Although the aetiologies of mycosis fungoides and Sézary syndrome are unknown, important insights have been gained in the immunological and genetic perturbations that are associated with these diseases. Unlike some B-cell lymphomas, cutaneous T-cell lymphomas as a group are rarely if ever curable and hence need chronic-disease management. New approaches to treatments are being investigated and include biological and cytotoxic drugs, phototherapy, and monoclonal antibodies that are directed towards novel molecular targets. New molecular technologies such as complementary-DNA microarray have the potential to increase the accuracy of diagnosis and provide important prognostic information. Treatments can be combined to greatly improve clinical outcome without substantially increasing toxic effects in advanced disease that is otherwise difficult to treat. Although present treatment strategies are generally not curative, there is hope that experimental treatments, particularly immunotherapy, might eventually reverse or suppress the abnormalities of mycosis fungoides and Sézary syndrome to the point at which they become non-life-threatening, chronic diseases.
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Affiliation(s)
- Sam T Hwang
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, USA.
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10
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Yamaguchi T, Takahashi H, Kagawa R, Takeda R, Sakata S, Yamamoto M, Nishizaki D, Yasui H. Synchronous Mucosa-Associated Lymphoid Tissue Lymphoma and Gastrointestinal Stromal Tumor of the Stomach Presenting with Gastric Bleeding. Am Surg 2008. [DOI: 10.1177/000313480807400311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report an extraordinarily rare case of synchronous mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor of the stomach. An 80-year-old man presented with gastric bleeding. Gastroscopy showed an ulcerative lesion and a submucosal tumor at the upper corpus of the stomach. The ulcerative lesion was proven by biopsy to be mucosa-associated lymphoid tissue lymphoma, but the submucosal tumor could not be diagnosed. Due to the repeating episodes of massive gastric bleeding, a total gastrectomy with lymphadenectomy was performed. After the operation, the submucosal tumor was pathologically proven to be a gastrointestinal stromal tumor. In this case, synchronous occurrence of mucosa-associated lymphoid tissue lymphoma and gastrointestinal stromal tumor seems to be coincidental rather than related with the same pathogenic triggering. Surgical resection of the stomach provided an accurate diagnosis and an effective treatment.
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11
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El-Zahabi LMN, Jamali FR, El-Hajj II, Naja M, Salem Z, Shamseddine A, El-Saghir NS, Zaatari G, Geara F, Soweid AM. The value of EUS in predicting the response of gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication. Gastrointest Endosc 2007; 65:89-96. [PMID: 17185085 DOI: 10.1016/j.gie.2006.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 05/10/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is associated with Helicobacter pylori infection, and regression of the tumor has been described after its eradication. OBJECTIVE To determine the value of EUS, in addition to other clinical/endoscopic features, in predicting the response of low-grade MALT lymphoma to H pylori eradication. DESIGN A retrospective, single-center study. SETTING AND PATIENTS Twenty-two patients with primary gastric MALT lymphoma were identified through a retrospective review of charts of patients seen at the American University of Beirut Medical Center. Only 19 patients with histopathologically confirmed gastric MALT lymphoma and H pylori infection who had EUS staging were included in the study. MAIN OUTCOME MEASUREMENTS Regression of the gastric MALT lymphoma as determined by follow-up endoscopy and mucosal biopsies. RESULTS Patients with disease restricted to the gastric mucosa had a significantly higher rate of complete remission after H pylori eradication compared with patients who had disease infiltrating into the gastric submucosa (77.8% vs 12.5%, P value .007). There was no statistical difference in terms of the mean follow-up time to achieve such response (P value .212). Age, sex, location of the tumor within the stomach, and endoscopic appearance did not correlate with the probability of complete remission of the MALT lymphoma. LIMITATIONS The limitations include a retrospective design and a relatively small sample population. CONCLUSION EUS determination of the invasion depth of gastric MALT lymphoma helps predict a complete response to H pylori eradication.
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Affiliation(s)
- Lara M N El-Zahabi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Bani-Hani KE, Yaghan RJ, Matalka II. Primary gastric lymphoma in Jordan with special emphasis on descriptive epidemiology. Leuk Lymphoma 2005; 46:1337-43. [PMID: 16109612 DOI: 10.1080/10428190500155660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to examine the clinicopathological features and epidemiology of primary gastric lymphoma in Jordan as a model for Middle East countries where such data is scarce. From 1991--2002, 219 patients with primary gastric malignancy were managed at our hospitals. Among these there were 19 patients with primary gastric lymphoma. Pertinent data for these patients were analyzed. Primary gastric lymphoma constituted 65.5% of all gastrointestinal lymphoma and 8.7% of all gastric malignancies. Male-to-female ratio was 2.8:1. The mean age was 56 years (range 39--82). The incidence was 0.6/100,000. The proximal third was the most common localisation. Abdominal pain was the commonest presentation. Low-grade MALT lymphomas, high-grade MALT lymphomas, diffuse large cell B lymphomas and T cell lymphoma were found in 21.1, 26.3, 47.4 and 5.3%, respectively. Nine patients had gastrectomy followed by chemotherapy, 6 patients had palliative resection, 3 patients had chemotherapy only and the remaining patient was treated with Helicobacter pylori eradication. The mean follow-up for all patients was 42.2 months. The 5-year survival rates for stages IE (n=5), IIE (n=4), IIIE (n=6) and IVE (n=4) were 100, 67, 27 and 0%, respectively (p=0.0003). The overall 5 years survival was 48.2%. Primary gastric lymphoma in Jordan shares some epidemiological features with western disease. Jordanian patients are detected and treated after a relatively long delay. Advanced stage at diagnosis correlated with poor outcome. There is a need of an earlier diagnosis and subsequent better care.
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Affiliation(s)
- K E Bani-Hani
- Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan.
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13
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Wang HH, Chou JW, Liao KF, Lin ZY, Lai HC, Hsu CH, Chen CB. One-year follow-up study of Helicobacter pylori eradication rate with 13C-urea breath test after 3-d and 7-d rabeprazole-based triple therapy. World J Gastroenterol 2005; 11:1680-4. [PMID: 15786549 PMCID: PMC4305953 DOI: 10.3748/wjg.v11.i11.1680] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the long-term role of a 3-d rabeprazole-based triple therapy in patients with Helicobacter pylori(H pylori)-infected active peptic ulcers.
METHODS: We prospectively studied 115 consecutive patients with H pylori-infected active peptic ulcers. H pylori infection was confirmed if any two of H pylori DNA, histology, and rapid urease test were positive. Patients were assigned to either an open-labeled 3-d course of oral amoxicillin 1000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d., or 7-d course of oral amoxicillin 1000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 20 mg b.i.d. Subsequently, all patients received oral rabeprazole 20 mg once daily until the 8th wk. Three months after therapy, all patients were followed-up endoscopically for the peptic ulcer, H pylori DNA, histology, and rapid urease test. One year after therapy, H pylori infection was tested using the 13C-urea breath test.
RESULTS: The ulcer healing rates 3 mo after therapy were 81.0% vs 75.4% for the 3-d and 7-d groups [intention-to-treat (ITT) analysis, P = 0.47] respectively, and 90.4% vs 89.6% for the 3-d and 7-d groups [per-protocol (PP) analysis, P = 0.89] respectively. The eradication rates 3 mo after therapy were 75.9% vs 73.7% for the 3-d and 7-d groups (ITT, P = 0.79) respectively, and 84.6% vs 87.5% for the 3-d and 7-d groups (PP, P = 0.68) respectively. One year after therapy, seventy-five patients returned to receive the 13C-urea breath test, and the eradication rates were 78.4% vs 81.6% in 3-d and 7-d groups (PP, P = 0.73) respectively.
CONCLUSION: Our study showed the eradication rates against H pylori infection 3 and 12 mo after triple therapy were not different between the 3-d and 7-d rabeprazole-based groups. Therefore, the 3-d rabeprazole-based triple therapy may be an alternative treatment for peptic ulcers with H pylori infection.
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Affiliation(s)
- Hwang-Huei Wang
- Division of Gastroenterology, Department of Internal Medicine, China Medical University Hospital, 2 Yuh-Der Road, North District, Taichung 404, Taiwan, China.
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14
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Gaucher D, Bodaghi B, Charlotte F, Schneider C, Cassoux N, Lemaitre C, Leblond V, Rao N, LeHoang P. Lymphome oculaire de type MALT simulant une sclérite ou une uvéite postérieure. J Fr Ophtalmol 2005; 28:31-8. [PMID: 15767896 DOI: 10.1016/s0181-5512(05)81022-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Diagnostic and therapeutic management of masquerade syndromes associated with MALT-type lymphoma. PATIENTS AND METHOD We report the cases of three patients referred for acute or chronic severe loss of visual acuity. All of them suffered from uveitis or scleritis resistant to corticoid treatment. Each one had posterior uveitis associated with retinochoroidal infiltration, anterior scleritis associated with uveal effusion syndrome, or bilateral pan-uveitis associated with serous retinal detachment. Two patients had medical records of systemic malignancies. They underwent an extensive work-up. Search for an infectious, immune or malignant disease was negative but orbital imaging showed a posterior scleral thickening in all cases. RESULTS Diagnosis of mucosa-associated lymphoid tissue (MALT) ocular lymphoma was assessed in all cases after scleral biopsy. Immunohistochemical analysis showed CD20(+) and CD5(-) scleral lymphocyte infiltrates. The three patients underwent chemotherapy associated with radiotherapy. Lesions were stabilized in the first case, whereas six lines of visual acuity improvement was noted in the second one, and full recovery was achieved after treatment in the third case. DISCUSSION Clinical manifestations of this ocular lesion seem to be multiple, masquerading as different types of posterior uveitis or scleritis. In the three cases, we did found other systemic locations of MALT-type lymphoma. Diagnosis was mainly based on pathological analysis. Fast visual recovery in two cases demonstrated the importance of an early diagnosis and a specific treatment. All cases of chronic and corticoid-resistant posterior uveitis require a specialized radiological evaluation followed, if necessary, by multiple orbital biopsies.
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Affiliation(s)
- D Gaucher
- Service d'Ophtalmologie, Groupe Hospitalier Pitié-Salpêtrière, 4783 boulevard de l'Hôpital, 756 Paris cedex 13, France
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15
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Cheng H, Wang J, Zhang CS, Yan PS, Zhang XH, Hu PZ, Ma FC. Clinicopathologic study of mucosa-associated lymphoid tissue lymphoma in gastroscopic biopsy. World J Gastroenterol 2003; 9:1270-2. [PMID: 12800238 PMCID: PMC4611798 DOI: 10.3748/wjg.v9.i6.1270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore and discuss the clinicopathologic characteristics of mucosa-associated lymphoid tissue (MALT) lymphoma in gastroscopic biopsy specimen.
METHODS: A retrospective study of 26 cases of lymphoma diagnosed by gastroscopic biopsy during 1999 to 2001 from gastroscopy files of Xijing Hospital was made. The diagnostic criteria were adopted according to the new classification of non-Hodgkin's lymphoma.
RESULTS: Twenty-six cases of primary gastric lymphoma consisting of 15 men and 11 women, aged between 23 to 76 years were recruited from 6225 cases who received gastroscopy. All of them were diagnosed by both endoscopic findings and histological examinations. Histologically, 23 cases were MALToma (low grade) and 3 cases lymphoblastic lymphoma (high grade). Immunohistochemically, all cases were CD20 positive, while CK and EMA were negative.
CONCLUSION: The majority of the cases of primary low-grade gastric lymphoma have morphologic and clinical features that justify their inclusion in the category of low-grade lymphoma of mucosa associated lymphoid tissue.
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Affiliation(s)
- Hong Cheng
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an 710033, Shaanxi Province, China
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16
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Insabato L, Di Vizio D, Tornillo L, D'Armiento FP, Siciliano A, Milo M, Palmieri G, Pettinato G, Terracciano LM. Clinicopathologic and immunohistochemical study of surgically treated primary gastric MALT lymphoma. J Surg Oncol 2003; 83:106-11. [PMID: 12772204 DOI: 10.1002/jso.10241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES B-cell MALT lymphoma is a well-recognized entity and its characterization as low-grade (LG) and high-grade (HG) lymphoma has been widely accepted. In the present study we reviewed a series of 95 surgical specimens of primary gastric MALT lymphoma selected between 1979 and 1998. Immunohistochemical expression of p53, bcl-2, and Ki67 and Helicobacter pylori (Hp) infection was evaluated, along with a correlation with clinical outcome. METHODS A morphologic and immunohistochemical analysis, including p53, bcl-2, and Ki67 expression, was carried out in all cases. A complete follow-up was obtained in 49 patients and in these cases a survival analysis was performed. RESULTS bcl-2 protein was highly expressed in 25 of 25 assessed LG tumors and in 20 of 24 assessed HG tumors. p53 protein was expressed in 13 of 25 assessed LG tumors and in 21 of 24 assessed HG tumors. High proliferation rate as expressed by Ki67 was detected in 15 of 25 assessed LG tumors and in 23 of 24 assessed HG tumors. Hp infection was detected in 11 of 16 assessed LG tumors and 2 of 10 assessed HG tumors. Median survival rates were 72 months for LG tumors and 24 months for HG tumors. CONCLUSIONS A significant inverse relationship between Hp infection and histological grade was found. High p53 expression and high-proliferation rate correlated with HG tumors. However, a correlation between p53, bcl-2, and Ki67 expression with clinical outcome was not found.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Gastrectomy
- Helicobacter Infections/pathology
- Helicobacter pylori
- Humans
- Immunohistochemistry
- Ki-67 Antigen/biosynthesis
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-2/biosynthesis
- Stomach Diseases/pathology
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/mortality
- Stomach Neoplasms/pathology
- Survival Rate
- Tumor Suppressor Protein p53/biosynthesis
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Affiliation(s)
- Luigi Insabato
- Department of Anatomic Pathology, School of Medicine, Federico II University of Naples, Naples, Italy.
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17
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Wang X, Willén R, Svensson M, Ljungh A, Wadström T. Two-year follow-up of Helicobacter pylori infection in C57BL/6 and Balb/cA mice. APMIS 2003; 111:514-22. [PMID: 12780527 DOI: 10.1034/j.1600-0463.2003.1110410.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Helicobacter pylori infection is associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma and MALT lymphoma. We previously found high-grade lymphoma after 13 months' H. pylori infection in C57BL/6 mice. In this study we followed H. pylori infection by three different isolates in C57BL/6 and Balb/cA mice for 23 months. Six-week-old C57BL/6 and Balb/cA mice were infected with H. pylori strains 119p (CagA+, VacA+), SS1 (CagA+, VacA+) and G50 (CagA-, VacA-). Mice were followed at 2 weeks, 10 weeks and 23 months post-inoculation (p.i.) by culture, histopathology and serology. Strain G50 was only reisolated from mice 2 weeks p.i. There was no difference in colonization between strain 119p and SS1 at 10 weeks p.i., whereas SS1 gave 100% colonization versus 119p gave 50% 23 months p.i. Interestingly, the inflammation score was higher in mice infected with strain 119p than with SS1 10-week p.i., and there were lymphoepithelial lesions in mice infected with strain 119p and G50 but not with SS1 at 23 months post-infection. Eight mice infected with strains 119p and G50 developed gastric lymphoma (grade 5 and 4). One C57BL/6 mouse infected with strain 119p developed hepatocellular carcinoma after 23 months. Immunoblot showed specific bands of 26-33 kDa against H. pylori in infected mice, and two mice infected with strain SSI reacted with antibodies to the 120 kDa CagA toxin. CONCLUSION A reproducible animal model for H. pylori-induced lymphoma and possibly hepatocellular carcinoma is described. Strain diversity may lead to different outcomes of H. pylori infection.
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Affiliation(s)
- Xin Wang
- Department of Medical Microbiology, University of Lund, Lund, Sweden
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18
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Taki C, Kitajima S, Sueyoshi K, Yonezawa S, Tanaka S, Sakoda K, Irimura T, Sato E, Goto M. MUC1 mucin expression in follicular dendritic cells and lymphoepithelial lesions of gastric mucosa-associated lymphoid tissue lymphoma. Pathol Int 2002; 52:691-701. [PMID: 12685546 DOI: 10.1046/j.1440-1827.2002.01411.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Membrane-associated mucin MUC1 is expressed in various adenocarcinoma cells and active T lymphocytes. We tried to find out whether MUC1 is expressed in gastric mucosa-associated lymphoid tissue (MALT) lymphoma lesion. MUC1 was not expressed in infiltrating T lymphocytes; however, MUC1 was found on the cell surface of follicular dendritic cells (FDC) of germinal centers and in the epithelial cytoplasm of lymphoepithelial lesion (LEL) of the lymphoma, which were immunohistochemically detected by monoclonal antibodies DF3 and MY.1E12. MUC1 was also expressed in the FDC of control cases (gastrectomy specimen containing reactive lymphoid follicles, n = 10, MUC1/ DF3, 100%; MUC1/MY.1E12, 40%), and FDC in MALT lymphomas (n = 59) showed lower MUC1 expression rates (MUC1/ DF3, 32%; MUC1/MY.1E12, 0%) than the control (P < 0.001). Lymphoepithelial lesion in the low-grade MALT lymphomas (n = 23) showed a higher MUC1/DF3 expression rate (30%) than those in the high-grade MALT lymphomas (n = 36; 6%; P < 0.05). T lymphocytes in the surface mucosa were more frequent in MALT lymphoma (91.4 +/- 80.6/unit area) than those in the control (20.0 +/- 23.6) (P < 0.001). S100-positive dendritic cells around LEL were more frequent in the low-grade (19.0 +/- 9.4/unit area) than in the high-grade (11.7 +/- 9.7) (P < 0.005). This study demonstrated MUC1 mucin expression on FDC for the first time. Mucosa-associated lymphoid tissue lymphoma, especially low-grade, shows immunologically active state, where FDC MUC1 expression may be suppressed by some factors released from lymphoma cells. Further study to elucidate the pathogenetic role of MUC1 in MALT lymphoma is necessary.
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Affiliation(s)
- Chiaki Taki
- Department of Pathology, Faculty of Medicine, Kagoshima University, Japan
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19
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Sandmeier D, Benhattar J, Bouzourene H. The natural history of a gastric low grade B cell MALT lymphoma followed during 11 years without treatment. J Clin Pathol 2002; 55:548-50. [PMID: 12101209 PMCID: PMC1769694 DOI: 10.1136/jcp.55.7.548] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Low grade B cell mucosa associated lymphoid tissue (MALT) lymphoma of the stomach is usually an indolent tumour that remains localised for a long time before dissemination occurs. MALT appears in the stomach in response to infection by Helicobacter pylori, which is present in 80-90% of cases. The pathogenesis of the evolution from chronic gastritis to malignant lymphoma has not yet been fully explained and the exact role of H pylori in the pathogenesis and progression of gastric lymphoma remains unclear. This report describes the case of a 72 year old woman with a low grade B cell MALT lymphoma localised in the gastric fundus, who refused to be treated for eradication of H pylori. The histological diagnosis of B cell MALT lymphoma was supported by both immunohistochemical and molecular genetic analysis. After 11 years of follow up, this MALT lymphoma remained indolent, without local progression or blastic transformation, and the H pylori infection was still persistent, even though the density of bacteria had decreased drastically. Interestingly, two different clonal immunoglobulin (Ig) gene rearrangements were found in two series of biopsies performed with an interval of 11 years. This case report supports the following notions: (1) H pylori associated gastritis is a risk factor for gastric MALT lymphoma, but might not be sufficient by itself for the progression of the disease, and (2) in the evolution of MALT lymphomas, different cell clones characterised by different Ig rearrangements may emerge.
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Affiliation(s)
- D Sandmeier
- Institute of Pathology, Bugnon 25, CH 1011 Lausanne, Switzerland
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20
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Ullrich A, Fischbach W, Blettner M. Incidence of gastric B-cell lymphomas: a population-based study in Germany. Ann Oncol 2002; 13:1120-7. [PMID: 12176793 DOI: 10.1093/annonc/mdf177] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While the clinical and experimental knowledge concerning gastric lymphomas is increasing, there is a scarcity of epidemiological data. PATIENTS AND METHODS A population-based sample of patients in Franconia and Saarland in Germany was collected from a clinical trial, hospital archives and a cancer registry. RESULTS Over a period of 3 years, 94 patients with primary gastric lymphoma were recorded out of a total population of 3.5 million. The standardised incidence rates in Saarland and Franconia were 0.7 and 0.8 cases per 100 000, respectively. Patients were predominantly from higher age groups (mean age 62.1 years) and the incidence in men was slightly more than in women (P <0.03). The distribution of histological subtypes in Franconia was as follows: marginal zone B-cell lymphomas (MZBL), 58%; diffuse large-cell B-cell lymphoma (DLBL), 33%; and mixed forms, 9%. Helicobacter pylori could be detected histologically in 84% of all cases, 95% of MZBL cases and 68% of DLBL cases. CONCLUSIONS Incidence rates of gastric lymphoma in Germany were similar to that in other European countries, except England, where rates are lower. The subtype-specific differences of H. pylori infection rates could be due to differences in carcinogenesis or to secondary changes during malignant transformation.
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Affiliation(s)
- A Ullrich
- School of Public Health, Department of Epidemiology and Medical Statistics, University of Bielefeld, Bielefeld.
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21
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Farinha P, André S, Cabeçadas J, Soares J. High frequency of MALT lymphoma in a series of 14 cases of primary breast lymphoma. Appl Immunohistochem Mol Morphol 2002; 10:115-20. [PMID: 12051628 DOI: 10.1097/00129039-200206000-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reports the clinicopathologic and immunohistochemical findings of 14 cases fulfilling the criteria of Wiseman and Liao for primary lymphoma of the breast (PBL), with emphasis on the frequency of mucosa-associated lymphoid tissue (MALT) lymphomas. The tumors were reclassified according to the revised European-American classification of lymphoid neoplasms. Immunohistochemistry was used to assist in the classification and subtyping of PBL, to demonstrate lymphoepithelial lesions (LEL), and to assess estrogen/progesterone receptor expression. Nine tumors were classified as MALT lymphomas (seven low grade and two high grade), four as diffuse large cell lymphomas and one as follicle center lymphoma. Extensive lymphoid cell infiltration of mammary ducts and acini was also found in non-MALT lymphoma cases. None of the 14 cases expressed hormonal receptors. Primary lymphoma of the breast is a rare and morphologically heterogeneous entity. There is similarity on the clinicopathologic overall profile of the current series of patients and those previously reported, but we recorded a higher incidence of MALT lymphoma (64.3%). Immunohistochemistry is mandatory to identify "true" LEL because epithelial permeation by lymphoid cells can also be found in non MALT-type lymphomas.
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Affiliation(s)
- Pedro Farinha
- Departamento de Patologia Morfológica, Instituto Português de Oncologia de Francisco Gentil, Centro de Lisboa.
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22
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Abstract
A number of scientific breakthroughs since H pylori first became recognized as a human pathogen have increased our understanding of the pathogenesis of gastroduodenal disease. In particular, advances in molecular bacteriology and the complete sequencing of the H pylori genome in 1999, and soon thereafter the human genome, provide tools allowing better delineation of the pathogenesis of disease. These molecular tools for both bacteria and host should now be applied to multicenter pediatric studies that evaluate disease outcome. More recent developments indicate that a better understanding of the microbial-host interaction is critical to furthering knowledge with respect to H pylori-induced diseases. Studies are needed to evaluate either DNA-based or more traditional protein-based vaccines, to evaluate more specific antimicrobials that confer minimal resistance, and to evaluate probiotics for the management of H pylori infection. Multicenter multinational studies of H pylori infection in the pediatric population, which include specific, randomized controlled eradication trials, are essential to extend current knowledge and develop better predictors of disease outcome.
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Affiliation(s)
- B D Gold
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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23
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Serralta Serra A, García Espinosa R, Planells Roig M, Prieto Rodríguez M. Regresión de linfoma gástrico no hodgkiniano tipo MALT con tratamiento erradicador de Helicobacter pylori. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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24
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Wotherspoon AC. A critical review of the effect of Helicobacter pylori eradication on gastric MALT lymphoma. Curr Gastroenterol Rep 2000; 2:494-8. [PMID: 11079052 DOI: 10.1007/s11894-000-0014-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Low-grade B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) are thought to arise within organized lymphoid tissue in the gastric mucosa that is most frequently acquired in response to Helicobacter pylori infection. This close association between the organism and the lymphoma is further reflected by the demonstration that the proliferation of the lymphoma cells can be driven by the presence of H. pylori organisms through a complex path of cellular interactions involving specific T cells. From these observations it was suggested that removal of one of the proliferative drives to the neoplastic cells in the form of eradication of the organism might induce a remission in the tumor. Several large multicenter studies are now underway to consider this question, and interim reports suggest that long-term remissions can be induced in low-grade MALT lymphomas in 70% to 80% of cases. The lymphomas that are most likely to respond to H. pylori eradication are those that are located superficially within the gastric mucosa. It has been suggested that certain genetic abnormalities, such as t(11;18) and the Bcl-10 mutation, may be associated with lack of response to this therapy. Recurrences of low-grade lymphoma are encountered in patients treated by H. pylori eradication, but these appear to be infrequent and may be self-limiting and spontaneously regress without further therapy.
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Affiliation(s)
- A C Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
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25
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Konturek PC, Konturek SJ, Starzyska T, Marlicz K, Bielanski W, Pierzchalski P, Karczewska E, Hartwich A, Rembiasz K, Lawniczak M, Ziemniak W, Hahn EC. Helicobacter pylori-gastrin link in MALT lymphoma. Aliment Pharmacol Ther 2000; 14:1311-8. [PMID: 11012476 DOI: 10.1046/j.1365-2036.2000.00832.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is accumulating evidence for the role of Helicobacter pylori in the development of gastric cancer as well as of lymphomas that arise in mucosa-associated lymphoid tissue (MALT). We reported recently that gastric cancer patients show high prevalence of cagA-positive H. pylori and express gastrin and gastrin receptors enabling them to stimulate tumour growth in autocrine fashion. AIMS Since the H. pylori infection is considered to be more strongly associated with MALT lymphoma than with gastric cancer, we decided to determine the gastrin and its receptors' mRNA expression and gastrin content in this tumour as well as the release of this hormone both into plasma and gastric lumen. Twenty MALT lymphoma patients were compared with 100 age- and gender-matched controls with similar dyspeptic symptoms. RESULTS The overall H. pylori seropositivity in MALT lymphoma was about 90% and CagA positivity was 70%, compared to 56% and 33%, respectively, in controls. The serum gastrin in MALT lymphoma was about sixfold higher than in controls while gastric luminal gastrin in these patients was over 70 times higher than in controls. Gastrin content in tumour was about 10-fold higher than in antral mucosa. Gastrin and gastrin-receptor (CCKB-receptor) mRNA were detected by reverse transcriptase-polymerase chain reaction in cancer tissue whilst in the fundic and antral mucosa, only enhanced expression of CCKB-receptor mRNA and gastrin mRNA was detected, respectively. Histamine stimulation in MALT lymphoma induced acid secretion that was only about 30% of control value due to atrophic gastritis. This study confirms an important role of CagA-positive H. pylori in the pathogenesis of MALT lymphoma and shows that this lymphoma is capable of synthesizing and releasing potent growth promoting gastrin, possibly due to the action on G-cells of H. pylori-originated Nalpha-methyl histamine and cytokines (tumour necrosis factor alpha and interleukin-8). CONCLUSIONS Gastric MALT lymphoma is closely linked to CagA-positive H. pylori infection. Gastrin and its receptors may be implicated in the pathogenesis of gastric lymphoma.
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Affiliation(s)
- P C Konturek
- Department of Medicine, University Erlangen-Nuremberg, Erlangen, Germany
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26
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Konturek SJ, Konturek PC, Hartwich A, Hahn EG. Helicobacter pylori infection and gastrin and cyclooxygenase expression in gastric and colorectal malignancies. REGULATORY PEPTIDES 2000; 93:13-9. [PMID: 11033048 DOI: 10.1016/s0167-0115(00)00173-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Helicobacter pylori, infecting more than 50% of the world population, results in gastritis, usually located in the antral portion of the stomach, accompanied by hypergastrinemia, the key factor in gastric and colorectal carcinogenesis. Excessive mucosal cell proliferation for many years may eventually result in gastric atrophy, cell mutation and transformation of gastric mucosal cells into gastrin-producing cells, which also express gastrin receptors serving to stimulate cell proliferation and tumor growth. These processes may be completed by the expression of cyclooxygenase-2 (COX-2) as an inflammation enzyme to release excessive amounts of PGE(2), leading to further proliferation, reduction in apoptosis, angiogenesis and tumor growth. H. pylori eradication results in complete regression of MALT lymphoma and subsequent normalisation of excessive gastrin release and COX-2 expression. Reduction of gastrin by active immunisation (gastrimmune), blocking of gastrin receptors with specific blockers and suppression of COX-2 might be helpful in inhibiting tumor growth and invasion.
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Affiliation(s)
- S J Konturek
- Department of Physiology, University Medical College, Ul. Grzegorzecka 16, Krakow, Poland
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27
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Abstract
Non-Hodgkin lymphoma (NHL) is the fifth most common cancer in the US, with about 55,000 new cases estimated for the year 2000. According to the new Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 1997, the age-adjusted incidence rates rose by about 80%, with an annual percentage increase of nearly 3%, which is faster than for the majority of cancers. The increasing incidence of NHL is largely unexplained. AIDS-related NHL accounts for some but not all of the increase. The American Cancer Society predicts about 7,400 new cases of Hodgkin Disease (HD) in the year 2000 in the US. The incidence of HD is consistently lower than that of NHL, and has decreased about 16% since the 1970s. Only a small portion of the decrease in HD incidence can be explained by misdiagnosis of HD as NHL. Further research is needed on the cofactors that predispose AIDS cases to lymphoma, as well as other possible causes of NHL such as immunosuppression, genetics, viruses, medical conditions, pesticides, solvents, hair dyes, and diet. Further evaluation of the role of viruses, occupational exposures, and genetics in the etiology of HD should prove valuable.
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Affiliation(s)
- D Baris
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20892, USA.
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28
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Skacel M, Ross CW, Hsi ED. A reassessment of primary thyroid lymphoma: high-grade MALT-type lymphoma as a distinct subtype of diffuse large B-cell lymphoma. Histopathology 2000; 37:10-8. [PMID: 10931213 DOI: 10.1046/j.1365-2559.2000.00941.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Primary lymphoma of the thyroid gland (PTL) is a relatively rare disease. During an 18-year period, 53 cases of primary non-Hodgkin's lymphoma involving this extranodal site were seen at our institutions. The aims of this study were to evaluate the spectrum of PTLs using current lymphoma classification concepts and immunocytochemical markers, determine whether features of MALT-type lymphoma were evident in PTL, and if there was any clinical significance of such a finding. METHODS AND RESULTS The cases were retrospectively studied clinically, histologically and immunohistochemically. The tumours were classified according to the Revised European-American Lymphoma Classification of lymphoid malignancies (REAL classification). Thirty-eight patients were females, 15 were males and mean age at diagnosis was 66.3 years (range 38-90). Three cases were low-grade marginal zone lymphomas (low-grade MALT-type lymphomas). There were 45 diffuse large B-cell lymphomas (DLBCL) of which there were 27 DLBCL-NOS and 18 high-grade MALT-type lymphomas. Within the diffuse large B-cell lymphoma (DLBCL) category, cases were subdivided into those without (DLBCL-NOS) and those with features of 'high-grade' MALT-type lymphoma based on presence of a low-grade component or large cell lymphoepithelial lesions (HG MALT-type lymphoma). In addition there were three follicle centre lymphomas, one anaplastic large cell lymphoma and one peripheral T-cell lymphoma. Twenty cases were stage IE, 18 stage IIE, and four stage IV. All patients with low-grade MALT-type lymphoma are alive without disease. The 5-year survivals for DLBCL-NOS and HG MALT-type lymphoma were 75% and 25%, respectively. Univariate analysis (log rank) among the DLBCLs showed stage (P < 0.001) and subtype (P = 0.005) were associated with survival. Stage was associated with type of DLBCL, 65% of DLBCL-NOS being stage IE compared to 20% of HG MALT-type lymphomas. CONCLUSIONS We conclude that primary thyroid lymphomas occur most commonly in elderly women and are frequently present in clinical stage IE and IIE. Low-grade MALT-type lymphomas are relatively uncommon but appear to have a favourable prognosis. DLBCL is the most common lymphoma and features of MALT can be seen in over one-third of cases. As a group, HG MALT-type lymphomas had a worse outcome than DLBCL-NOS, primarily due to higher clinical stage at diagnosis. These two subtypes of DLBCL appear to be distinct clinical and histological entities.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Immunohistochemistry
- Immunophenotyping
- Lymphoma, B-Cell, Marginal Zone/classification
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Retrospective Studies
- Survival Analysis
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
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Affiliation(s)
- M Skacel
- Cleveland Clinic Foundation, Cleveland, OH, University of Michigan, Ann Arbor, MI, USA
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Gasbarrini A, Gabrielli M, Fiore G, Candelli M, Bartolozzi F, De Luca A, Cremonini F, Franceschi F, Di Campli C, Armuzzi A, Ojetti V, Serricchio M, Pola R, Gasbarrini G, Giacovazzo M, Pola P. Association between Helicobacter pylori cytotoxic type I CagA-positive strains and migraine with aura. Cephalalgia 2000; 20:561-5. [PMID: 11075839 DOI: 10.1046/j.1468-2982.2000.00077.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent studies have suggested an association between Helicobacter pylori infection and migraine. However, various strains of the bacterium are present, some endowed with greater pathogenicity. In particular, H. pylori type I CagA-positive strains induce a higher release of proinflammatory substances by the gastric mucosa that could trigger systemic vasospasms. The aim of the present study was to assess the prevalence of H. pylori CagA-positive strains in subjects with migraine. One hundred and seventy-five patients affected by migraine (49 with aura, 126 without aura) were consecutively enrolled and matched for sex, age, social background and geographical origin with 152 controls. Helicobacter pylori infection was assessed through 13C-urea breath test. Specific serological IgG against CagA were detected through ELISA. The prevalence of H. pylori infection was similar in migraine patients and in controls (40% vs. 39%, respectively). Among migraine patients, prevalence of infection was not related to presence or absence of aura (45% vs. 37%, respectively). However, among infected subjects, a significantly higher prevalence of CagA-positive strains was observed in patients affected by migraine with aura when compared with those affected by migraine without aura (41% vs. 19%, P < 0.01) and with controls (41% vs. 17%, P < 0.01). CagA-positive H. pylori strains were found to be strongly associated with migraine with aura. A higher inflammatory response of the gastric mucosa to more virulent strains could release substances that may act as triggers of vasospasm in peculiar cerebral arterial districts, probably implicated in the 'aura' phenomenon.
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Affiliation(s)
- A Gasbarrini
- Angiology Department, Catholic University, Rome, Italy.
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Maes B, Baens M, Marynen P, De Wolf-Peeters C. The product of the t(11;18), an API2-MLT fusion, is an almost exclusive finding in marginal zone cell lymphoma of extranodal MALT-type. Ann Oncol 2000; 11:521-6. [PMID: 10907943 DOI: 10.1023/a:1008357314157] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Extranodal marginal zone cell lymphoma (MZCL) of MALT-type share similar features with nodal and splenic MZCL regarding morphology and immunophenotype. At the genetic level, recent cytogenetic studies have shown that t(11;18) is a recurring abnormality in extranodal MALT-type MZCL but has hitherto never been reported in nodal or splenic MZCL. The aim of the present study was to determine the prevalence of t(11;18) in a large series of nodal, splenic and extranodal MALT-type MZCL, using a sensitive real-time RT-PCR method. MATERIALS AND METHODS Ninety-three MZCL cases were divided on clinical grounds into 61 extranodal MALT-type, 19 splenic and 12 nodal MZCL. One case that presented with a massive splenomegaly but for which also gastro-intestinal localisations were found, was left unclassified. A real-time RT-PCR method for the detection of the API2-MLT fusion resulting from t(11;18) was performed on RNA extracted from frozen tissue sections. RESULTS The API2-MLT fusion was detected in 12 cases, which were all extranodal MALT-type lymphomas of the stomach, except for one case. The remaining positive case was the unclassified case, for which the translocation was detected in the spleen and in hilar lymph node tissue. CONCLUSIONS While similarities between MZCL from different anatomic sites have lend us to propose that all MZCL have a common normal counterpart, the almost exclusive detection of t(11;18) in gastric MALT-type lymphoma favours its recognition as a separate lymphoma entity. The absence of the translocation in nodal and splenic MZCL challenges the idea of these lymphomas being secondary to MALT-type lymphomas of the gut. The unclassified case illustrates the inadequate approaches available at present to identify and define the various MZCL.
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Affiliation(s)
- B Maes
- Department of Pathology, University of Leuven, Belgium.
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Schechter NR, Yahalom J. Low-grade MALT lymphoma of the stomach: a review of treatment options. Int J Radiat Oncol Biol Phys 2000; 46:1093-103. [PMID: 10725618 DOI: 10.1016/s0360-3016(99)00522-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach (MLS) is often associated with the presence of Helicobacter pylori (H. pylori) bacteria. Eradication of the infection with antibiotic therapy may result in regression of the lymphoma. But when antibiotic treatment fails to reverse the malignant process or if H. pylori is absent, other treatment options should be considered. Because MLS is often confined to the stomach and regional lymph nodes, it is potentially curable with local therapy. Endoscopy and improved imaging, with endoscopic ultrasound (EUS) and computerized tomography (CT), have reduced the prior dependence on surgery for diagnosis and staging of gastric lymphomas. METHODS AND RESULTS This review details the advances in the diagnosis, classification, and imaging of MLS. We also describe the experience that supports the use of radiation therapy as the preferred treatment of MLS in patients who have not responded to antibiotic therapy or have not had evidence for H. pylori infection. CONCLUSIONS Radiation therapy for MLS is not only effective and safe, but offers the significant advantage of low morbidity and gastric function preservation.
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Affiliation(s)
- N R Schechter
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Genta RM, Franceschi F. Treating biopsies to cure patients: the management of histological findings in mucosa-associated lymphoid tissue (MALT). J Clin Gastroenterol 1999; 29:116-7. [PMID: 10478869 DOI: 10.1097/00004836-199909000-00003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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