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Feng Y, Duan TJ, Huang Q, Li ZY, Liu YP, Luo MS, Lu GF, Shi W, Zhang ZY, Li HX. The clinicopathological characteristics of gastric cancer and precancerous conditions in gastric DLBCL and MALT lymphoma patients: a multi-center retrospective study. Ann Med 2023; 55:2193423. [PMID: 37183786 DOI: 10.1080/07853890.2023.2193423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE The objective of this study is to explore the clinicopathological characteristics of gastric cancer and precancerous conditions in patients with primary gastric lymphoma. METHODS We analyzed 474 cases of primary gastric lymphoma, mainly DLBCL and MALT, from three clinical centres retrospectively, and compared the clinicopathological parameters of primary gastric lymphoma patients complicated with gastric cancer, precancerous conditions, or with no complications. RESULTS A total of 5.1% of the patients with primary gastric lymphoma were diagnosed with gastric cancer, including metachronous gastric adenocarcinoma (3.2%) and synchronous gastric adenocarcinoma (1.9%). Of the patients with gastric lymphoma, 14.6% had precancerous conditions including atrophy (14.6%), intestinal metaplasia (8.9%), and low-grade intraepithelial neoplasia (1.9%). Primary gastric lymphoma patients with an ulcerative type (p = 0.009) and Lugano classification stage IIE + IV (p < 0.001) lymphoma had a higher risk of complicating with gastric cancers or precancerous conditions. The rate of infection of Helicobacter pylori (Hp) was 68.4% in patients with primary gastric lymphoma, which was higher in patients with MALT lymphoma (p < 0.001), Lugano classification stage I + II (p < 0.001), and patients complicated with precancerous conditions and gastric cancer (p < 0.001), especially gastric cancer of the intestinal type (p = 0.04). Gastric cancer (95.8%) and precancerous conditions (91.3%) occurred mostly in Hp-infected primary gastric lymphoma patients, with a minor subset of Hp-eradicated patients. Primary gastric lymphoma patients had a higher detection rate of early gastric cancer (25.0%) and a five-year survival rate (40.0%) than the general Chinese population. CONCLUSIONS Patients with primary gastric lymphoma have a high risk of developing gastric cancer and precancerous conditions, and this risk may be related to Helicobacter pylori infection. Follow-up of primary gastric lymphoma provides an opportunity for the detection of early gastric cancer.Key messages5.1% of the patients with primary gastric lymphoma were diagnosed with gastric cancer.14.6% of the patients with gastric lymphoma had premalignant lesions including atrophy (14.6%), intestinal metaplasia (8.9%), and low-grade intraepithelial neoplasia (1.9%).Primary gastric lymphoma patients complicating with gastric cancer had a higher infection rate of Helicobacter pylori (100.0%), a detection rate of early gastric cancer (25.0%) and a five-year survival rate (40.0%) than the general Chinese population.
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Affiliation(s)
- Yun Feng
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Tian-Jiao Duan
- Department of Gastroenterology, Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China
| | - Qing Huang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Zhi-Yi Li
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Ya-Ping Liu
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Miao-Sha Luo
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Gui-Fang Lu
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Wen Shi
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Zhi-Yong Zhang
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Hong-Xia Li
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
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Peng YH, Feng X, Zhou Z, Yang L, Shi YF. Helicobacter pylori infection in Xinjiang Uyghur Autonomous Region: Prevalence and analysis of related factors. World J Gastroenterol 2023; 29:5834-5847. [PMID: 38074913 PMCID: PMC10701308 DOI: 10.3748/wjg.v29.i43.5834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND 14C urea breath test (14C UBT) and immunohistochemical staining (IHC) are widely used for detection Helicobacter pylori (H. pylori) infection with different sensitivity, and there is a difference in H. pylori infection rate in Uyghur and Han ethnic groups. Both need large cohort studies to evaluate the differences more accurately. AIM To analyze the difference between 14C UBT and IHC for H. pylori detection in Xinjiang Uyghur Autonomous Region and the difference between Uyghur and Han populations. METHODS There were 3944 cases of H. pylori infection detected by both IHC and 14C UBT at the same time (interval < 1 wk, with sampling site including gastric antrum, selected from 5747 patients). We compared the sensitivity of 14C UBT and IHC. We also compared 555 pairs of Han/Uyghur cases (completely matched for gender and age) for their H. pylori infection rates. The overall H. pylori infection rate of all 5747 cases and the correlation with other clinicopathological data were also further analyzed. SPSS V23.0 software was used for statistical analysis. RESULTS The sensitivity was 94.9% for 14C UBT and 65.1% for IHC, which was a significant difference (n = 3944, P < 0.001). However, among those cases negative for H. pylori by 14C UBT (detection value ≤ 100), 4.8% were positive by IHC. Combining both methods, the overall H. pylori infection rate was 48.6% (n = 5747), and differences in gender, age group, ethnicity and region of residence significantly affected the H. pylori positive rates. According to age group (Han/Uyghur), the positive rates were ≤ 30 years (62.2%/100.0%), 31-40 years (45.2%/85.7%), 41-50 years (47.2%/79.2%), 51-60 years (44.6%/76.1%), 61-70 years (40.9%/68.2%), 71-80 years (41.7%/54.1%) and ≥ 81 years (42.9%/NA). The H. pylori infection rates of Han/Uyghur paired cases were 41.4% and 73.3%, which was a significant difference (P < 0.001) (555 pairs). H. pylori positivity was significantly related to moderate-severe grade 2-3 chronic/active gastritis and intestinal metaplasia (all P < 0.05). CONCLUSION The sensitivity of 14C UBT was significantly higher, but combined application can still increase the accuracy. The prevention H. pylori should be emphasized for Uygur and young people.
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Affiliation(s)
- Yu-Hua Peng
- Department of Pathology, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Xue Feng
- Department of Laboratory Medicine, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Zhong Zhou
- Department of Pathology, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
| | - Lei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yun-Fei Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Tran QT, Nguyen Duy T, Nguyen-Tran BS, Nguyen-Thanh T, Ngo QT, Tran Thi NP, Le V, Dang-Cong T. Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study. Diagnostics (Basel) 2023; 13:2767. [PMID: 37685305 PMCID: PMC10486743 DOI: 10.3390/diagnostics13172767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11-99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25-59.6%) and ulcer type (15.6-50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.
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Affiliation(s)
- Quang Trung Tran
- Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany;
- Gastroenterology-Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue 49000, Vietnam
| | - Thinh Nguyen Duy
- Faculty of Medicine and Pharmacy, Tay Nguyen University, 567 Le Duan Street, Buon Ma Thuot 63000, Vietnam;
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Bao Song Nguyen-Tran
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Tung Nguyen-Thanh
- Faculty of Basic Science, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam;
| | - Quy Tran Ngo
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Nam Phuong Tran Thi
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
| | - Vi Le
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
- Department of Pathology, Khanh Hoa Oncology Hospital, 229 Nguyen Khuyen Street, Nha Trang 57000, Vietnam
| | - Thuan Dang-Cong
- Department of Histology, Embryology, Pathology and Forensic, University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen Street, Hue 49000, Vietnam; (B.S.N.-T.); (Q.T.N.); (N.P.T.T.); (V.L.)
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Saito M, Mori A, Ogasawara R, Izumiyama K, Morioka M, Kondo T, Miyashita K. Progression of Primary Gastric Diffuse Large B-Cell Lymphoma after Helicobacter pylori Eradication. Case Rep Gastroenterol 2020; 14:534-539. [PMID: 33250694 PMCID: PMC7670362 DOI: 10.1159/000508849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
In Helicobacter pylori−positive, localized primary gastric diffuse large B-cell lymphoma (DLBCL), an increasing number of reports have recently been published on the effectiveness of H. pylori eradication (HPE). However, HPE treatment strategies for gastric DLBCL, including its indications, have yet to be examined. No detailed report has been published on a case of gastric DLBCL unsuccessfully treated by HPE. A 64-year-old female and a 70-year-old male were pathologically diagnosed with chronic active gastritis and mucosa-associated lymphoid tissue lymphoma, respectively. Both patients were positive for H. pylori, so HPE was employed. The disease progressed within 1 year, and both patients were pathologically diagnosed with DLBCL by endoscopic biopsy. On reviewing the first pathology slide, both patients were diagnosed with DLBCL. That is, the 2 patients had primary gastric DLBCL; however, they exhibited progressive disease after HPE. This failure of HPE treatment may be due to the initial lymphomas being multiplex ulcerative lesions. In both cases, complete remission was achieved by chemotherapy (plus radiation therapy) without recurrence for more than 3 years.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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Tsai HJ, Tai JJ, Chen LT, Wu MS, Yeh KH, Lin CW, Wang TE, Wang HP, Yu FJ, Liou JM, Hsiao CF, Cheng TY, Yeh HJ, Ko CW, Chen MJ, Lo GH, Hsu PI, Chang CS, Hwang WS, Chuang SS, Lee HW, Shun CT, Chiu CF, Wang WM, Hsieh CY, Liu TW, Lin JT, Kuo SH, Cheng AL. A multicenter prospective study of first-line antibiotic therapy for early-stage gastric mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma with histological evidence of mucosa-associated lymphoid tissue. Haematologica 2019; 105:e349-e354. [PMID: 31727764 DOI: 10.3324/haematol.2019.228775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hui-Jen Tsai
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - John Jen Tai
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan.,Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Tsang-En Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Fang-Jung Yu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Chin-Fu Hsiao
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Tsu-Yao Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Hong-Jen Yeh
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Chung-Wang Ko
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei
| | - Gin-Ho Lo
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Ping-I Hsu
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Cheng-Shyong Chang
- Department of Internal Medicine, Changhua Christian Hospital, Changhua City
| | | | - Shih-Sung Chuang
- Department of Pathology, National Taiwan University Hospital, Taipei.,Department of Pathology, Chi-Mei Medical Center, Tainan.,Department of Pathology, School of Medicine, Taipei Medical University, Taipei
| | - Hsiao-Wei Lee
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei
| | - Chang-Fang Chiu
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Wen-Ming Wang
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Ching-Yun Hsieh
- Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Tainan
| | - Jaw-Town Lin
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
| | - Ann-Lii Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei.,Department of Medical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei
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Mahachai V, Vilaichone RK, Pittayanon R, Rojborwonwitaya J, Leelakusolvong S, Maneerattanaporn M, Chotivitayatarakorn P, Treeprasertsuk S, Kositchaiwat C, Pisespongsa P, Mairiang P, Rani A, Leow A, Mya SM, Lee YC, Vannarath S, Rasachak B, Chakravuth O, Aung MM, Ang TL, Sollano JD, Trong Quach D, Sansak I, Wiwattanachang O, Harnsomburana P, Syam AF, Yamaoka Y, Fock KM, Goh KL, Sugano K, Graham D. Helicobacter pylori management in ASEAN: The Bangkok consensus report. J Gastroenterol Hepatol 2018; 33:37-56. [PMID: 28762251 DOI: 10.1111/jgh.13911] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022]
Abstract
Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review and evaluate clinical aspects of H. pylori infection and to develop consensus statements, rationales, and grades of recommendation for the management of H. pylori infection in clinical practice in ASEAN countries. This ASEAN Consensus consisted of 34 international experts from 10 ASEAN countries, Japan, Taiwan, and the United States. The meeting mainly focused on four issues: (i) epidemiology and disease association; (ii) diagnostic tests; (iii) management; and (iv) follow-up after eradication. The final results of each workshop were presented for consensus voting by all participants. Statements, rationale, and recommendations were developed from the available current evidence to help clinicians in the diagnosis and treatment of H. pylori and its clinical diseases.
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Affiliation(s)
- Varocha Mahachai
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Ratha-Korn Vilaichone
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Rapat Pittayanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | | | | | - Monthira Maneerattanaporn
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Peranart Chotivitayatarakorn
- Department of Medicine, Thammasat University Hospital, Khlong Luang, Pathumthani, Thailand.,National Gastric Cancer and Gastrointestinal Diseases Research Center, Bangkok, Pathumthani, Thailand
| | - Sombat Treeprasertsuk
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chomsri Kositchaiwat
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pisaln Mairiang
- Department of Medicine, Faculty of Medicine, KhonKaen University, Khon Kaen, Thailand
| | - Aziz Rani
- Department of Gastroenterology and Hepatology, University of Jakarta, Jakarta, Indonesia
| | - Alex Leow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Swe Mon Mya
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Oung Chakravuth
- Calmette Hospital, University of Health Science, Phnom Penh, Cambodia
| | - Moe Myint Aung
- Department of Gastroenterology, Yangon General Hospital, Yangon, Myanmar
| | - Tiing-Leong Ang
- Department of Gastroentrology and Hepatology, Changi General Hospital, Singapore
| | - Jose D Sollano
- Section of Gastroenterology, University of Santo Tomas Hospital, Manila, Philippines
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | | | | | | | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Depok, Indonesia
| | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kwong-Ming Fock
- Faculty of Medicine, National University of Singapore, Singapore
| | - Khean-Lee Goh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - David Graham
- Department of Medicine, Gastroenterology Section, Baylor College of Medicine and Michael E. DeBakey VA Medicine Center, Houston, Texas, USA
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Beham-Schmid C. Aggressive lymphoma 2016: revision of the WHO classification. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2017; 10:248-254. [PMID: 29250206 PMCID: PMC5725508 DOI: 10.1007/s12254-017-0367-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022]
Abstract
Aggressive lymphomas are a heterogeneous group of malignancies reflecting clinical, biological and pathological diversity. Diffuse large B‑cell lymphoma is the most common histological subtype and therefore will constitute the key aspect in this article. This lymphoma affects patients of all age groups with wide range presentations concerning localization, morphology and molecular mechanisms. The median age at presentation is about 60 years with a slight male preponderance. Up to 50% of patients present with advanced disease. About 70% of these lymphomas occur nodal, about 30% extranodal, the most common sites of the latter being the gastrointestinal tract, Waldeyer’s ring, skin, cerebrum, mediastinum, testis, salivary gland, thyroid and bone. However, diffuse large B‑cell lymphoma can involve virtually any organ.Since the last WHO classification 2008 the adoption of new genomic technologies has provided new insights into the biology of these lymphomas and led to the identification of distinct separate molecular entities and novel pathogenic pathways. These findings induced an expanding number of entities in the new WHO classification of 2016, the knowledge of which is essential concerning treatment options and survival of the patients. Therefore, the clinicians request an accurate diagnosis from the investigating pathologist, which can be quite challenging. The diagnosis of lymphomas requires multiple immunohistochemical studies, and often additional tests, such as fluorescent in situ hybridization and/or polymerase chain reaction techniques and occasionally, in particular cases, next generation sequencing for identification of recurrent somatic mutations. This review summarizes relevant aspects of the new WHO classification in aggressive B‑cell lymphomas, especially from a haematopathologist’s point of view.
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Affiliation(s)
- Christine Beham-Schmid
- Institute of Pathology, Medical University Graz, Neue Stiftingtalstr. 6, 8010 Graz, Austria
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8
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Gong EJ, Ahn JY, Jung HY, Park H, Ko YB, Na HK, Jung KW, Kim DH, Lee JH, Choi KD, Song HJ, Lee GH, Kim JH. Helicobacter pylori Eradication Therapy Is Effective as the Initial Treatment for Patients with H. pylori-Negative and Disseminated Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Gut Liver 2017; 10:706-13. [PMID: 27114423 PMCID: PMC5003192 DOI: 10.5009/gnl15510] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS We investigated the effectiveness of Helicobacter pylori eradication therapy for gastric mucosaassociated lymphoid tissue (MALT) lymphoma regardless of the H. pylori infection status or disease stage. METHODS From November 1995 to September 2014, 345 subjects who were diagnosed with gastric MALT lymphoma and had received eradication therapy as their first-line treatment were eligible for inclusion in this study. A retrospective review was performed using the medical records. RESULTS Of the 345 patients, H. pylori infection was detected in 317 patients (91.9%). The complete remission (CR) rate after eradication therapy was 82.3%, which was higher in H. pylori -positive patients than in H. pylori-negative patients (84.5% vs 57.1%, p=0.001). CR rates after eradication did not present significant differences between stages, and the CR rate was 83.3% for stage IE1 and 74.4% for stage IE2 or above (p=0.167). The overall CR rate was 87.2% after additional treatment, and neither H. pylori infection status nor stage showed differences according to the treatment response. CONCLUSIONS Eradication therapy led to CR in 57.1% of H. pylori-negative patients and in 74.4% of patients with stage IE2 or above. Eradication therapy is worthwhile as an initial treatment for gastric MALT lymphoma regardless of the H. pylori infection status and stage.
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Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungchul Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Bo Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Expressions of the CagA protein and CagA-signaling molecules predict Helicobacter pylori dependence of early-stage gastric DLBCL. Blood 2017; 129:188-198. [DOI: 10.1182/blood-2016-04-713719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 11/09/2016] [Indexed: 02/08/2023] Open
Abstract
Key Points
Expression of CagA and CagA-signaling molecules p-SHP2 and p-ERK is associated with HP dependence of gastric DLBCL. CagA is associated with the direct lymphomagenic effect of HP on B cells of HP-dependent gastric DLBCL.
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10
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Gagnaire A, Nadel B, Raoult D, Neefjes J, Gorvel JP. Collateral damage: insights into bacterial mechanisms that predispose host cells to cancer. Nat Rev Microbiol 2017; 15:109-128. [DOI: 10.1038/nrmicro.2016.171] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Weng CH, Wang RC, Wu CC, Lin TH. Treatment of synchronous adenocarcinoma and lymphoma of the stomach: A case report. Mol Clin Oncol 2016; 5:783-785. [PMID: 28101357 DOI: 10.3892/mco.2016.1044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/18/2016] [Indexed: 12/17/2022] Open
Abstract
Gastric cancer is one of the leading causes of cancer-related mortality worldwide. The majority of gastric cancers are diagnosed at an advanced or metastatic stage, with a 5-year survival rate of ~5-20% and a median overall survival of <1 year. Synchronous occurrence of gastric adenocarcinoma and lymphoma is rare, and thus far there is no consensus regarding their management. We herein describe a case of synchronous gastric adenocarcinoma and diffuse large B-cell lymphoma in a patient with chronic hepatitis B and the treatment strategy. A literature review with the most up-to-date treatment options and their application in similar situations was also performed.
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Affiliation(s)
- Chien-Hsiang Weng
- NH Dartmouth Family Medicine Residency, Concord Hospital, Concord, NH 03301, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; Division of Hematology/Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, R.O.C
| | - Ren-Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, R.O.C
| | - Cheng-Chung Wu
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan, R.O.C
| | - Tseng-Hsi Lin
- Division of Hematology/Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, R.O.C.; Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan, R.O.C.; Department of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan, R.O.C
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12
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Hu Q, Zhang Y, Zhang X, Fu K. Gastric mucosa-associated lymphoid tissue lymphoma and Helicobacter pylori infection: a review of current diagnosis and management. Biomark Res 2016; 4:15. [PMID: 27468353 PMCID: PMC4962427 DOI: 10.1186/s40364-016-0068-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/04/2016] [Indexed: 02/07/2023] Open
Abstract
Helicobacter pylori (H. pylori)-associated gastritis is one of the most common infectious diseases in the United States, China and worldwide. Gastric mucosa-associated tissue lymphoma (MALT lymphoma) is a rare mature B-cell neoplasm associated with H. pylori infection that is curable by antibiotics therapy alone. The pathological diagnosis of gastric MALT lymphoma can be reached by histological examination, immunohistochemical staining and B-cell clonality analysis. H. pylori eradication is the choice of therapy for early-stage gastric MALT lymphoma. High response rates and long-term survival have been reported in refractory and localized diseases treated with low-dose radiation therapy. Systemic chemotherapy is recommended for advanced-stage gastric MALT lymphoma and cases with large B-cell lymphoma transformation. Recent advances in the pathological diagnosis and management of gastric MALT lymphoma are reviewed in this article.
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Affiliation(s)
- Qinglong Hu
- Tucson Pathology Associates, PC Carondelet Saint Joseph Hospital, 351 North Wilmot Road, Tucson, AZ 85711 USA
| | - Yizhuo Zhang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060 China
| | - Xiaoyan Zhang
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE 68198 USA
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13
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Van Nuffel AM, Sukhatme V, Pantziarka P, Meheus L, Sukhatme VP, Bouche G. Repurposing Drugs in Oncology (ReDO)-clarithromycin as an anti-cancer agent. Ecancermedicalscience 2015; 9:513. [PMID: 25729426 PMCID: PMC4341996 DOI: 10.3332/ecancer.2015.513] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Indexed: 12/17/2022] Open
Abstract
Clarithromycin (CAM) is a well-known macrolide antibiotic available as a generic drug. CAM is traditionally used for many types of bacterial infections, treatment of Lyme disease and eradication of gastric infection with Helicobacter pylori. Extensive preclinical and clinical data demonstrate a potential role for CAM to treat various tumours in combination with conventional treatment. The mechanisms of action underlying the anti-tumour activity of CAM are multiple and include prolonged reduction of pro-inflammatory cytokines, autophagy inhibition, and anti-angiogenesis. Here, we present an overview of the current preclinical (in vitro and in vivo) and clinical evidence supporting the role of CAM in cancer. Overall these findings justify further research with CAM in many tumour types, with multiple myeloma, lymphoma, chronic myeloid leukaemia (CML), and lung cancer having the highest level of evidence. Finally, a series of proposals are being made to further investigate the use of CAM in clinical trials which offer the greatest prospect of clinical benefit to patients.
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Affiliation(s)
| | | | - Pan Pantziarka
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium ; The George Pantziarka TP53 Trust, London KT1 2JP, UK
| | - Lydie Meheus
- Anticancer Fund, Brussels, 1853 Strombeek-Bever, Belgium
| | - Vikas P Sukhatme
- GlobalCures, Inc, Newton, MA 02459, USA ; Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA 02215, USA
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14
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Zhang Y, Gao W, Cheng H, Zhang X, Hu F. Tetracycline- and furazolidone-containing quadruple regimen as rescue treatment for Helicobacter pylori infection: a single center retrospective study. Helicobacter 2014; 19:382-6. [PMID: 24849129 DOI: 10.1111/hel.12143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Eradication rate of Helicobacter pylori decreases worldwide, while antibiotics resistance rates of H. pylori increase rapidly in recent years. In most cases, H. pylori would be resistant to clarithromycin, metronidazole, and quinolone if these antibiotics had been used as component of eradication regimen. H. pylori strains resistant to both tetracycline and furazolidone are rare. The aim of our study was to evaluate efficacy and side effects of tetracycline- and furazolidone-containing quadruple regimen as rescue treatment. METHODS Patients with H. pylori infection given RTFB (rabeprazole 20 mg b.i.d. + tetracycline 750 mg b.i.d. +furazolidone 100 mg b.i.d. + colloidal bismuth subcitrate 200 mg b.i.d.) regimen for 14 days as rescue treatment were enrolled in this retrospective study. Eradication status was evaluated by (13) C-urea breath test, and side effects were collected. RESULTS One hundred and nine patients were enrolled. The intention-to-treat eradication rate was 91.74% (100 of 109) and 95.24% (100 of 105) per protocol analysis. Side effects including fever, palpitation, and skin rash occurred in 35 patients. CONCLUSIONS The 14-day tetracycline- and furazolidone-containing quadruple regimen can achieve a relatively high eradication rate as rescue treatment. Some side effects including fever may occur during the treatment.
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Affiliation(s)
- Yuemiao Zhang
- Department of Integrated TCM & Western Medicine, Peking University First Hospital, Beijing, China
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15
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Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 2014; 20:12781-12808. [PMID: 25278678 PMCID: PMC4177463 DOI: 10.3748/wjg.v20.i36.12781] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/17/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.
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16
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Cuccurullo R, Govi S, Ferreri AJM. De-escalating therapy in gastric aggressive lymphoma. World J Gastroenterol 2014; 20:8993-8997. [PMID: 25083073 PMCID: PMC4112900 DOI: 10.3748/wjg.v20.i27.8993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/14/2014] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
The treatment of primary gastric diffuse large B-cell lymphoma (DLBCL) has changed radically over the last 10–15 years, with the abandonment of routine gastrectomy in favor of more conservative therapies. Low-level evidence suggests that consolidation radiotherapy could be avoided in patients with limited-stage DLBCL of the stomach who achieve complete remission after rituximab-CHOP combination. Small, recent prospective trials suggest that selected patients with limited-stage Helicobacter pylori (H. pylori)-positive DLBCL of the stomach and favorable prognostic factors can be managed with antibiotics alone, with excellent disease control and cure rates, keeping chemo-radiotherapy for unresponsive patients. This recommendation should equally regard patients with mucosa-associated lymphoid tissue-related or de novo DLBCL. Future studies should be focused on the establishment of reliable variables able to distinguish the best candidates for exclusive treatment with H. pylori eradication from those who need for conventional chemo-immunotherapy.
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MESH Headings
- Animals
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemoradiotherapy
- Gastrectomy
- Helicobacter Infections/diagnosis
- Helicobacter Infections/drug therapy
- Helicobacter Infections/microbiology
- Helicobacter pylori/drug effects
- Helicobacter pylori/pathogenicity
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Patient Selection
- Remission Induction
- Risk Factors
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/radiotherapy
- Treatment Outcome
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17
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Jia CW, Sun J, Gu YM, Zhang TT, Liu MY, Chen J, Lu ZH. Application of the BIOMED-2 standardized primer system for the diagnosis of primary gastric B-cell non-Hodgkin's lymphoma. APMIS 2014; 122:873-9. [PMID: 24698154 DOI: 10.1111/apm.12250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Abstract
Primary gastric B-cell non-Hodgkin's lymphoma (B-NHL) has a similar morphocytological presentation to severe chronic gastritis, which complicates the pathological diagnosis of this disease. To investigate the practicality and utility of the BIOMED-2 standardized primer system for the diagnosis of primary gastric B-NHL from endoscopic biopsy specimens, we selected 65 cases of archived paraffin-embedded primary gastric B-NHL specimens as well as 27 cases of severe chronic gastritis samples to serve as a negative control group. The positivity rates of immunoglobulin heavy chain (IgH) gene rearrangements detected by the BIOMED-2 standardized primer system for the two groups were 86.4% and 12.0%, respectively, which are significantly different (p < 0.05). Importantly, the combined detection of the five groups of the IgH primer system increased the detection rate of B-NHL. These findings indicate that the BIOMED-2 standardized primer system is suitable for formalin-fixed and paraffin-embedded (FFPE) specimens and is valuable as a secondary diagnostic tool for primary gastric B-NHL as well as the differential diagnosis of severe chronic gastritis.
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Affiliation(s)
- Cong-Wei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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The role of Helicobacter pylori eradication in the treatment of diffuse large B-cell and marginal zone lymphomas of the stomach. Curr Opin Oncol 2014; 25:470-9. [PMID: 23942292 DOI: 10.1097/01.cco.0000432523.24358.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This review is focused on the effect of Helicobacter pylori eradication with antibiotics in patients with primary gastric lymphomas of indolent and aggressive nature. RECENT FINDINGS Gastrointestinal lymphoma is the most common form of extranodal lymphoma, involving primarily the stomach in 60-75% of cases. The most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT)-type. H. pylori infection has been implicated in the pathogenesis of gastric MALT lymphoma; its role in gastric DLBCL remains controversial. Recently, international guidelines established that patients with gastric MALT lymphoma should be treated with upfront H. pylori-eradicating antibiotic therapy and that residual microscopic or molecular disease does not need for additional antiblastic treatment. The excellent prognosis of patients with gastric DLBCL managed with conservative chemo-radiotherapy led some investigators to test H. pylori eradication as exclusive treatment in prospective trials, keeping chemo-radiotherapy for unresponsive patients. This conservative strategy was well tolerated and active in patients with limited-stage DLBCL (±MALT areas) of the stomach. SUMMARY H. pylori eradication is a suitable strategy as exclusive upfront treatment for both patients with MALT-type lymphomas or with DLBCL of the stomach. Additional trials are needed to elucidate related controversial issues.
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19
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Zullo A, Hassan C, Ridola L, Repici A, Manta R, Andriani A. Gastric MALT lymphoma: old and new insights. Ann Gastroenterol 2014; 27:27-33. [PMID: 24714739 PMCID: PMC3959547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022] Open
Abstract
The stomach is the most frequent site of extranodal lymphoma. Gastric lymphoma originating from mucosa-associated lymphoid tissue (MALT) is typically a low-grade, B-cell neoplasia strongly associated with Helicobacter pylori (H. pylori) infection. Only certain H. pylori strains in some predisposed patients determine lymphoma development in the stomach, according to a strain-host-organ specific process. The clinical presentation is poorly specific, symptoms ranging from vague dyspepsia to alarm symptoms. Similarly, different endoscopy patterns have been described for gastric lymphoma. H. pylori eradication is advised as first-line therapy in early stage disease, and complete lymphoma remission is achieved in 75% of cases. Neoplasia stage, depth of infiltration in the gastric wall, presence of the API2-MALT1 translocation, localization in the stomach, and patient ethnicity have been identified as predictors of remission. Recent data suggests that H. pylori eradication therapy may be successful for gastric lymphoma treatment also in a small subgroup (15%) of H. pylori-negative patients. The overall 5-year survival and disease-free survival rates are as high as 90% and 75%, respectively. Management of patients who failed to achieve lymphoma remission following H. pylori eradication include radiotherapy, chemotherapy and, in selected cases, surgery.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome (Angelo Zullo, Cesare Hassan, Lorenzo Ridola),
Correspondence to: Dr. Angelo Zullo, Ospedale Nuovo Regina Margherita, Gastroenterologia ed Endoscopia Digestiva, Via Emilio Morosini, 30, 00153 Rome, Italy, e-mail:
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome (Angelo Zullo, Cesare Hassan, Lorenzo Ridola)
| | - Lorenzo Ridola
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, Rome (Angelo Zullo, Cesare Hassan, Lorenzo Ridola)
| | - Alessandro Repici
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan (Alessandro Repici)
| | - Raffaele Manta
- Gastroenterology and Endoscopy Unit, New S. Agostino Hospital, Modena (Raffaele Manta)
| | - Alessandro Andriani
- Onco-Hematology Unit, ‘Nuovo Regina Margherita’ Hospital, Rome (Alessandro Andriani), Italy
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20
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Guo Q, Guo S, Zhang Y. Treatment of gastric MALT lymphoma with a focus on Helicobacter pylori eradication. Int J Hematol 2013; 97:735-42. [PMID: 23616223 DOI: 10.1007/s12185-013-1348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 02/08/2023]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent disease with a prolonged clinical course that most often involves the stomach. Clinically, for Helicobacter pylori-positive low-grade MALT lymphoma, antibiotics have been used as the first-line treatment. The recommended anti-Helicobacter triple drug therapy includes a proton pump inhibitor (or ranitidine bismuth citrate), clarithromycin, and amoxicillin (or metronidazole). Considering the difficulty involved with confirming histological remission and the lack of systemic endoscopic follow-up, much work remains to be done in this area. This review describes MALT lymphoma treatment methods and their efficacy, highlights results of the newest studies, and proposes avenues toward future developments in this field.
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Affiliation(s)
- Qing Guo
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Huan-Hu-Xi Road, Ti-Yuan-Bei, He Xi District, Tianjin, People's Republic of China
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21
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Kuo SH, Cheng AL. Helicobacter pylori and mucosa-associated lymphoid tissue: what's new. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:109-117. [PMID: 24319171 DOI: 10.1182/asheducation-2013.1.109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach, gastric MALT lymphoma, is associated with Helicobacter pylori infection. The eradication of H pylori using antibiotics is successful in 60% to 80% of affected patients. In contrast to the previous paradigm, we and other investigators have shown that a certain proportion of patients with H pylori-positive early-stage diffuse large B-cell lymphoma (DLBCL) of the stomach with histological evidence of MALT lymphoma, including high-grade transformed gastric MALT lymphoma and gastric DLBCL(MALT), achieved long-term complete pathological remission (pCR) after first-line H pylori eradication therapy, indicating that the loss of H pylori dependence and high-grade transformation are separate events in the progression of gastric lymphoma. In addition, patients with H pylori-positive gastric DLBCL without histological evidence of MALT (gastric pure DLBCL) may also respond to H pylori eradication therapy. A long-term follow-up study showed that patients who achieved pCR remained lymphoma free. Gastric MALT lymphoma is indirectly influenced by H pylori infection through T-cell stimulation, and recent studies have shown that H pylori-triggering chemokines and their receptors, H pylori-associated epigenetic changes, H pylori-regulated miRNA expression, and tumor infiltration by CD4+CD25+ regulatory T cells contribute to lymphomagenesis of gastric MALT lymphoma. Recent studies have also demonstrated that the translocation of CagA into B lymphocytes inhibits apoptosis through p53 accumulation, BAD phosphorylation, and the up-regulation of Bcl-2 and Bcl-XL expression. In gastric MALT lymphoma, CagA may stimulate lymphomagenesis directly, through the regulation of signal transduction, and intracellular CagA is associated with H pylori dependence. These findings represent a substantial paradigm shift compared with the classical theory of H pylori-reactive T cells contributing indirectly to the development of MALT lymphoma. In conclusion, a wide range of H pylori-related gastric lymphomas have been identified. The use of antibiotics as the sole first-line therapy for early-stage gastric pure DLBCL requires validation in a prospective study. The clinical and biological significance of the CagA oncoprotein in the lymphomagenesis of gastric MALT lymphoma warrants further study.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/immunology
- Cell Transformation, Neoplastic/metabolism
- Epigenesis, Genetic/immunology
- Gastric Mucosa/immunology
- Gastric Mucosa/metabolism
- Gastric Mucosa/microbiology
- Helicobacter Infections/genetics
- Helicobacter Infections/immunology
- Helicobacter Infections/metabolism
- Helicobacter Infections/therapy
- Helicobacter pylori/genetics
- Helicobacter pylori/immunology
- Helicobacter pylori/metabolism
- Humans
- Lymphoid Tissue/immunology
- Lymphoid Tissue/metabolism
- Lymphoid Tissue/microbiology
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Signal Transduction/genetics
- Signal Transduction/immunology
- Stomach Neoplasms/genetics
- Stomach Neoplasms/immunology
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/mortality
- Stomach Neoplasms/therapy
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/immunology
- Tumor Suppressor Protein p53/metabolism
- bcl-X Protein/genetics
- bcl-X Protein/immunology
- bcl-X Protein/metabolism
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Helicobacter pylori eradication therapy is effective in the treatment of early-stage H pylori-positive gastric diffuse large B-cell lymphomas. Blood 2012; 119:4838-44; quiz 5057. [PMID: 22403257 DOI: 10.1182/blood-2012-01-404194] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An explorative study evaluates the efficacy of Helicobacter pylori (HP) eradication (HPE) therapy on early-stage gastric diffuse large B-cell lymphomas (DLBCLs) without features of mucosa-associated lymphoid tissue (MALT), the pure (de novo) DLBCLs, in comparison with its efficacy on high-grade transformed gastric MALT lymphomas, the DLBCL(MALT). In total, 50 patients of stage IE/IIE1 HP-positive gastric DLBCLs with frontline HPE treatment were included. HP infection was successfully eradicated in 100% (16/16) of the pure (de novo) DLBCL patients and 94.1% (32/34) of the DLBCL(MALT) patients. In total, 68.8% (11/16) of pure (de novo) DLBCL patients and 56.3% (18/32) of DLBCL(MALT) patients achieved complete pathologic remission (pCR) after HPE therapy. The median time to pCR was 2.1 months (95% confidence interval, 0.6%-3.7%) for pure (de novo) DLBCLs and 5.0 months (95% confidence interval, 2.8%-7.5%; P = .024) for DLBCL(MALT). At a median follow-up of 7.7 years, all patients with pCR after HPE therapy were alive and free of lymphomas, except for one patient with pure (de novo) DLBCL who died of lung cancer. Similar to DLBCL(MALT), a substantial portion of early-stage HP-positive gastric pure (de novo) DLBCLs remains HP-dependent and responds to antibiotic treatment. Prospective studies to validate the findings are warranted.
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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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Jacobs G, Hellmig S, Huse K, Titz A, Franke A, Kwiatkowski R, Ott S, Kosmahl M, Fischbach W, Lucius R, Klapper W, Fölsch UR, Hampe J, Schreiber S, Rosenstiel P. Polymorphisms in the 3'-untranslated region of the CDH1 gene are a risk factor for primary gastric diffuse large B-cell lymphoma. Haematologica 2011; 96:987-95. [PMID: 21459793 DOI: 10.3324/haematol.2010.033126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Primary gastric B-cell lymphomas arise from mucosa-associated lymphatic tissue (MALT) in patients with chronic Helicobacter pylori infection. We investigated whether germline variants in the CDH1 gene, coding for E-cadherin, genetically predispose patients to primary gastric B-cell lymphoma. DESIGN AND METHODS Single marker analyses of the CDH1 gene were conducted in patients with primary gastric B-cell lymphoma (n=144), in patients with primary gastric high-grade lymphoma (n=61), and in healthy blood donors (n=361). Twelve single nucleotide polymorphisms were genotyped by TaqMan(®) technology. Allelic imbalance was tested by pyrosequencing and clone direct sequencing of heterozygote genomic and cDNA. Mutation detection was conducted around the poly-A signal of the CDH1 3'-untranslated region. The influence of the 3'-untranslated region on protein translation was determined by a luciferase reporter assay. RESULTS Single marker analyses identified two single nucleotide polymorphisms in strong linkage disequilibrium located in the CDH1 3'-untranslated region. One of them was significantly associated with primary gastric diffuse large B-cell lymphomas after correction for multiple testing and this association was confirmed in an independent sample set. Patients homozygous for the rare T allele (rs1801026) had a 4.9-fold increased risk (95% CI: 1.5-15.9) of developing primary gastric diffuse large B-cell lymphoma. Allelic imbalance and reporter gene assays indicated a putative influence on mRNA stability and/or translational efficacy. CONCLUSIONS We identified variants in CDH1 as the first potential genetic risk factors for the development of primary gastric diffuse large B-cell lymphomas. One of the potentially causative variants affects allelic CDH1 expression. These findings support the hypothesis that besides somatic alterations of B-cells, germline variants in the CDH1 gene contribute to a predisposition to the development of primary gastric diffuse large B-cell lymphomas.
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Affiliation(s)
- Gunnar Jacobs
- Institute of Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany
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Dyer MJS, Ye H, Isaacson PG. Primary lymphoma-like lesions of the uterine cervix; sheep in wolves' clothing. Br J Haematol 2011; 153:791-4. [PMID: 21410452 DOI: 10.1111/j.1365-2141.2011.08659.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Although scientific knowledge in viral oncology has exploded in the 20th century, the role of bacteria as mediators of oncogenesis has been less well elucidated. Understanding bacterial carcinogenesis has become increasingly important as a possible means of cancer prevention. This review summarizes clinical, epidemiological, and experimental evidence as well as possible mechanisms of bacterial induction of or protection from malignancy.
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Abstract
GOAL To assess the clinical and endoscopic presentation of primary gastric lymphoma. BACKGROUND Remission rate and long-term survival in patients with gastric lymphoma mainly depend on disease stage at diagnosis. Series reporting clinical and endoscopic presentation of gastric lymphoma are generally small and heterogeneous. STUDY Systematic review with pooled-data analysis assessing clinical and endoscopic presentation of primary gastric lymphoma. RESULTS Data regarding 2000 patients were collected. Overall, males were slightly more prevalent, alarm symptoms were absent in near half of the patients, lymphoma was diagnosed in a stage >I in one-third of the patients, and Helicobacter pylori infection was present in 88.8% of considered patients. At endoscopy, the ulcerative type was the most frequent presentation, although low-grade lymphoma was diagnosed on normal/hyperemic gastric mucosa in 9% of cases. Patients with high-grade lymphoma presented alarm symptoms (anemia and/or melena and/or hemorrhage, persistent vomiting, weight loss), an exophytic or ulcerative lesion, a stage III-IV, and a H. pylori negative status more frequently than low-grade lymphoma cases. CONCLUSIONS Our pooled-data analysis showed that gastric lymphoma is still disappointingly diagnosed in an advanced stage in a large number of patients. This is probably due to presence of nonspecific symptoms at initial clinical presentation and/or a normal appearing mucosa at endoscopic observation in the early stages.
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Zullo A, Hassan C, Cristofari F, Perri F, Morini S. Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond. World J Gastrointest Oncol 2010; 2:181-6. [PMID: 21160595 PMCID: PMC2998825 DOI: 10.4251/wjgo.v2.i4.181] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 10/18/2009] [Accepted: 10/25/2009] [Indexed: 02/05/2023] Open
Abstract
The stomach is the most frequently involved site for extranodal lymphomas, accounting for nearly two-thirds of all gastrointestinal cases. It is widely accepted that gastric B-cell, low-grade mucosal-associated lymphoid tissue (MALT)-lymphoma is caused by Helicobacter pylori (H. pylori) infection. MALT-lymphomas may engender different clinical and endoscopic patterns. Often, diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa. H. pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage (I-II1). Neoplasia confined to the submucosa, localized in the antral region of the stomach, and without API2-MALT1 translocation, shows a high probability of remission following H. pylori eradication. When both bacterial infection and lymphoma recur, further eradication therapy is generally effective. Radiotherapy, chemotherapy and, in selected cases, surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission, while data on immunotherapy with monoclonal antibodies (rituximab) are still scarce. The 5-year survival rate is higher than 90%, but careful, long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.
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Affiliation(s)
- Angelo Zullo
- Angelo Zullo, Cesare Hassan, Francesca Cristofari, Sergio Morini, Gastroenterology and Digestive Endoscopy, "Nuovo Regina Margherita" Hospital, 00153 Roma, Italy
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Zullo A, Hassan C, Cristofari F, Andriani A, De Francesco V, Ierardi E, Tomao S, Stolte M, Morini S, Vaira D. Effects of Helicobacter pylori eradication on early stage gastric mucosa-associated lymphoid tissue lymphoma. Clin Gastroenterol Hepatol 2010; 8:105-10. [PMID: 19631287 DOI: 10.1016/j.cgh.2009.07.017] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 07/08/2009] [Accepted: 07/11/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Different remission rates of gastric low-grade, B-cell, mucosa-associated lymphoid tissue (MALT) lymphoma have been reported after Helicobacter pylori eradication. We assessed the long-term remission and relapse rates of early stage MALT lymphoma in patients treated only by H pylori eradication and identified factors that might predict outcome. METHODS This systematic review analyzed data from 32 studies, including 1408 patients. RESULTS The MALT lymphoma remission rate was 77.5% (95% confidence interval, 75.3-79.7), and was significantly higher in patients with stage I than stage II(1) lymphoma (78.4% vs 55.6%; P = .0003) and in Asian than in Western groups (84.1% vs 73.8%; P = .0001). Neoplasia confined to the submucosa regressed more frequently than that with deeper invasion (82.2% vs 54.5%; P = .0001); patients with lymphoma localized to the distal stomach experienced regression more frequently than those with lymphoma of the proximal stomach (91.8% vs 75.7%; P = .0037). The remission rate was higher among patients without the API2-MALT1 translocation than in those with this translocation (78% vs 22.2%; P = .0001). In an analysis of data from 994 patients, 7.2% experienced lymphoma relapse during 3253 patient-years of follow-up evaluation, with a yearly recurrence rate of 2.2%. Infection and lymphoma were cured by additional eradication therapy in all patients with H pylori recurrence (16.7%). Five (0.05%) of the patients initially cured of lymphoma developed high-grade lymphoma within 6 to 25 months of therapy. CONCLUSIONS H pylori eradication is effective in treating approximately 75% of patients with early stage gastric lymphoma. Long-term follow-up evaluation of these patients is needed to detect early lymphoma relapse or progression.
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Affiliation(s)
- Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy.
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Epstein Barré Virus-Negative Diffuse Large B-Cell Lymphoma in an HIV-Infected Man with a Durable Complete Remission on Highly Active Antiretroviral Therapy Alone. South Med J 2010; 103:76-80. [DOI: 10.1097/smj.0b013e3181c48001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baumgaertner I, Copie-Bergman C, Levy M, Haioun C, Charachon A, Baia M, Sobhani I, Delchier JC. Complete remission of gastric Burkitt’s lymphoma after eradication of Helicobacter pylori. World J Gastroenterol 2009; 15:5746-50. [PMID: 19960575 PMCID: PMC2789231 DOI: 10.3748/wjg.15.5746] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Burkitt’s lymphoma is a highly aggressive non-Hodgkin lymphoma, often presenting in extra-nodal sites. It generally has a poor spontaneous outcome and needs aggressive treatment with systemic and intrathecal chemotherapy. Occurrence at the gastric site is rare. We report the case of a 39-year old woman who presented with a prominent ulcerated lesion of the antrum corresponding histologically to a Burkitt’s lymphoma associated with Helicobacter pylori (H pylori) infection. Interphase fluorescence in situ hybridization (FISH) demonstrated c-MYC gene rearrangement in tumour cells without BCL2 or BCL6 gene translocations. Ulcer healing and tumour regression with a complete histological response were obtained 8 wk after H pylori eradication. In spite of this complete remission, taking into account the high risk of recurrence, the patient received systemic and intrathecal chemotherapy. Two years later, the patient remained in complete remission. This is the first report of a gastric Burkitt’s lymphoma responding to H pylori eradication. These findings raise the question of the potential role of H pylori in the pathogenesis of some gastric Burkitt’s lymphomas, and show the importance of searching for and eradicating the bacteria in combination with conventional chemotherapy regimens.
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Incidence of extranodal non-Hodgkin lymphomas among whites, blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences. Cancer Epidemiol 2009; 33:337-46. [PMID: 19853554 DOI: 10.1016/j.canep.2009.09.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/19/2009] [Accepted: 09/23/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Extranodal non-Hodgkin lymphoma (NHL) accounts for much of the increase in NHL incidence in the past three decades in the United States, but its descriptive epidemiology is scarce in the literature. METHODS Incidence data for the years 1999-2003 were from 38 population-based cancer registries, covering 82% of US population. We grouped anatomic sites of extranodal NHLs according to the Surveillance, Epidemiology, and End Results (SEER) site recodes, and histology subtypes according to the nested classification of lymphoid neoplasms developed by the Pathology Working Group of the International Lymphoma Epidemiology Consortium. RESULTS Blacks and Asians/Pacific Islanders (APIs) experienced incidence rates about the same as or lower than whites' for B-cell extranodal NHL as a whole and most of its histologic subtypes. The significant exceptions are: API men had a 40% higher rate of marginal zone lymphoma (MZL) than white men, and API women had a 12% higher rate of diffuse large B-cell lymphoma (DLBCL) than white women. The rates of all T-cell extranodal NHLs combined and peripheral T-cell lymphoma (PTCL) among black women exceeded those of white women by 46% and 18%, respectively. Blacks also had higher rates of mycosis fungoides (MF) than whites (28% higher for men and 99% higher for women). The most common sites of extranodal NHL are stomach, skin, and oral cavity and pharynx. Compared with whites, blacks had either lower or similar incidence of NHL for all sites except skin for women while APIs had higher rates of NHL of the stomach, nose/nasal cavity/middle ear, colorectum (women only), and brain (men only). Age was associated with race- and sex-specific differences in histology-specific incidence rates. CONCLUSION While blacks and APIs had lower or similar overall incidence rates for extranodal NHL, they experienced excessive rates in some subtypes. Blacks had higher rates of the two most common types of T-cell extranodal NHL and APIs had higher rate of the two common types of B-cell types than whites. Distinct race-specific patterns in histology- and site-specific incidence of extranodal NHL may implicate racial differences in risk factor exposure and/or genetic predisposition.
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Zullo A, Hassan C, Andriani A, Cristofari F, De Francesco V, Ierardi E, Tomao S, Morini S, Vaira D. Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis. Am J Gastroenterol 2009; 104:1932-7; quiz 1938. [PMID: 19532131 DOI: 10.1038/ajg.2009.314] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Helicobacter pylori eradication is recognized as the initial therapy for gastric low-grade, B-cell, mucosa-associated lymphoid tissue (MALT) lymphoma. This study assesses (i) the H. pylori eradication rates for various first- and second-line and rescue therapies and (ii) the associated reinfection rates in patients. METHODS Pooled data analysis of systematic review of the literature was performed in this study. RESULTS Data from 34 studies with 1,271 treated patients were used. After first-line therapy, the infection was cured in 91% (95% confidence interval (CI)=89.4-92.5) of cases, the eradication rate being higher after dual therapy compared with the 7- or 14-day triple therapies (P=0.0525). After second-line therapy, the eradication rate was 80.8% (95% CI=82.7-95.1), being higher after triple rather than quadruple therapy. Further therapies (from three to five attempts) cured the infection in 75% of patients. H. pylori infection was ultimately cured in 1,250 patients, resulting in eradication rates of 98.3% (95% CI=97.6-99) and 99.8% (95% CI=99.6-100) at intention-to-treat and per-protocol analysis levels, respectively. Bacterial reinfection occurred in 18 (2.7%; 95% CI=1.4-3.9) of 676 patients who were followed-up (0.7% yearly). Overall, gastric lymphoma remission was achieved in 973 (77.8%) of 1,250 patients successfully cured of H. pylori infection. CONCLUSIONS This was the first comprehensive ( approximately 1,300 patients) analysis of the therapeutic management of H. pylori in gastric lymphoma patients. Data suggest that this infection is easily managed in these patients, being cured in nearly all cases.
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Affiliation(s)
- Angelo Zullo
- Department of Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Via E. Morosini, 30, Rome 00153, Italy.
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Stasi R, Evangelista ML, Brunetti M, Bussa S, Maritati R, Gallo A, Turrini L, Taccogna S, Crescenzi A, Angelini F. Primary gastric plasmacytoma and Helicobacter pylori infection. J Clin Oncol 2008; 27:150-3. [PMID: 19047299 DOI: 10.1200/jco.2008.19.8341] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Roberto Stasi
- Division of Oncology and Hematology, Regina Apostolorum Hospital, Albano Laziale, Italy
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Dong G, Liu C, Ye H, Gong L, Zheng J, Li M, Huang X, Huang X, Huang Y, Shi Y, Yin W, Gao Z. BCL10 nuclear expression and t(11;18)(q21;q21) indicate nonresponsiveness to Helicobacter pylori eradication of Chinese primary gastric MALT lymphoma. Int J Hematol 2008; 88:516-523. [PMID: 18949449 DOI: 10.1007/s12185-008-0187-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 09/18/2008] [Accepted: 09/19/2008] [Indexed: 01/11/2023]
Abstract
The eradication of Helicobacter pylori (H. pylori) with antibiotics induces complete remission in 75% of patients with gastric MALT lymphoma. We investigated the efficacy of H. pylori eradication and assessed the predictive value of BCL10 nuclear expression and t(11;18)(q21;q21) regarding resistance to H. pylori eradication in primary gastric mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) patients from mainland China. Twenty-two gastric MALT cases (Stage I(E)) underwent H. pylori eradication with antibiotics, and sequential endoscopic-bioptic follow-ups were performed and assessed with regular morphologic and immunohistochemical examinations. BCL10 nuclear expression and interphase fluorescence in situ hybridization (FISH) for MALT1 and API2/MALT1 were tested. Thirteen out of the 22 cases (59.1%) achieved complete regression (CR) after the eradication of H. pylori. The longest follow-up period in the 22 patients was 68 months, with 12 patients longer than 24 months. For the 13 CR patients, the longest follow-up period after H. pylori eradication was 53 months, with 6 patients longer than 24 months. BCL10 nuclear expression was detected by immunohistochemical staining in 9 cases, including 7 (77.8%) of 9 cases who showed no response (NR) and 2 (15.4%) of 13 patients who achieved CR following eradication therapy (P < 0.05). t(11;18)(q21;q21) was evaluated by interphase FISH in 18 cases including 11 CR and 7 NR patients after H. pylori eradication. t(11;18)(q21;q21) was found in 4 (57.1%) of 7 patients who showed NR following H. pylori eradication, but one in 11 CR patients (P < 0.05). A total of 59.1% of patients with early gastric MALT lymphoma recruited in this study achieved CR after H. pylori eradication. BCL10 nuclear expression and t(11;18)(q21;q21)-positive gastric MALT lymphomas are likely to be related to a failure to respond to H. pylori eradication in Chinese patients.
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MESH Headings
- Adaptor Proteins, Signal Transducing/biosynthesis
- Adaptor Proteins, Signal Transducing/genetics
- Adolescent
- Adult
- Aged
- Anti-Bacterial Agents/administration & dosage
- Asian People
- B-Cell CLL-Lymphoma 10 Protein
- China
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/metabolism
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 18/metabolism
- Female
- Follow-Up Studies
- Gene Expression Regulation, Neoplastic/drug effects
- Helicobacter Infections/drug therapy
- Helicobacter Infections/genetics
- Helicobacter Infections/metabolism
- Helicobacter Infections/mortality
- Helicobacter Infections/pathology
- Helicobacter pylori
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Male
- Middle Aged
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/genetics
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/mortality
- Stomach Neoplasms/pathology
- Translocation, Genetic
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Affiliation(s)
- Gehong Dong
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Cuiling Liu
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Hongtao Ye
- Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, UK
- Department of Pathology, Guilin Medical College, 541004, Guilin, People's Republic of China
| | - Liping Gong
- Department of Pathology, Capital Medical University, 100069, Beijing, People's Republic of China
| | - Jie Zheng
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Min Li
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Xin Huang
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Xuebiao Huang
- Department of Digestive Disease, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Yuanjie Huang
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Yunfei Shi
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Wenjuan Yin
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China
| | - Zifen Gao
- Department of Pathology, Peking University Health Science Center, 100191, Beijing, People's Republic of China.
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