1
|
De Sanctis V, Marignani M, Angeletti S, Assisi D, Armosini V, Valeriani M, Minniti G, Cox MC, Ruco L, Enrici RM. Anti-Helicobacter Pylori Therapy in Primary MALT Lymphoma of Rectum. TUMORI JOURNAL 2018; 98:e105-10. [DOI: 10.1177/030089161209800423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary rectal MALT lymphoma is a very rare entity among extranodal MALT lymphomas and its therapeutic management has not been standardized. Different approaches including surgery, chemotherapy and radiotherapy have been proposed in the last decades. There have been reports on complete responses after anti-Helicobacter pylori therapy, also in patients without serological or histological evidence of Helicobacter pylori infection. In our patient we obtained a complete response with anti-Helicobacter pylori therapy and a disease-free survival of 34 months. Endoscopic ultrasound was useful for diagnosis and follow-up. Although the mechanisms that determined this response remain a matter of debate, anti-Helicobacter pylori therapy can be considered as first-line therapy in stage IE, nonbulky primary rectal MALT lymphoma. Endoscopic ultrasound could play a relevant role in the management of this rare condition.
Collapse
Affiliation(s)
| | - Massimo Marignani
- Department of Digestive and Liver Disease, Sapienza University, S Andrea Hospital, Rome
| | - Stefano Angeletti
- Department of Digestive and Liver Disease, Sapienza University, S Andrea Hospital, Rome
| | - Daniela Assisi
- Department of Digestive and Liver Disease, Sapienza University, S Andrea Hospital, Rome
| | - Veronica Armosini
- Department of Radiotherapy, Sapienza University, S Andrea Hospital, Rome
| | - Maurizio Valeriani
- Department of Radiotherapy, Sapienza University, S Andrea Hospital, Rome
| | - Giuseppe Minniti
- Department of Radiotherapy, Sapienza University, S Andrea Hospital, Rome
| | | | - Luigi Ruco
- Hematology Unit, S Andrea Hospital, Rome
| | | |
Collapse
|
2
|
Kelley SR. Mucosa-associated lymphoid tissue (MALT) variant of primary rectal lymphoma: a review of the English literature. Int J Colorectal Dis 2017; 32:295-304. [PMID: 27995323 DOI: 10.1007/s00384-016-2734-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE Primary rectal lymphoma (PRL) is the third most common cause of rectal cancer following adenocarcinoma (90-95 %) and carcinoid (5 %). The most common variant of PRL is the mucosa-associated lymphoid tissue (MALT) type. To date, no study has been able to recommend an optimal treatment algorithm for this rare disease. The aim of our study was to review the English literature on primary rectal MALT lymphoma. METHODS A review of the English literature was conducted to identify articles describing the MALT variant of PRL. RESULTS Fifty-one cases were identified. A complete response was achieved in 12 of 19 cases treated with Helicobacter pylori eradication therapy, 5 of 6 with radiation, 2 of 4 cases with chemotherapy, 2 of 4 with endoscopic resection, 6 of 8 cases with surgical resection, and all 8 with combination therapies. Cases failing initial therapies were responsive to various second-line treatments. Two cases spontaneously regressed with observation alone. CONCLUSION Complete regression of primary rectal MALT lymphoma was achieved using various therapeutic strategies, although the numbers of different treatment modalities are too small to draw definitive conclusions.
Collapse
Affiliation(s)
- Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
3
|
Yonal-Hindilerden I, Hindilerden F, Arslan S, Turan-Guzel N, Dogan IO, Nalcaci M. Primary B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma of the Hard Palate and Parotid Gland: Report of One Case and Review of the Literature. J Clin Med Res 2016; 8:824-830. [PMID: 27738485 PMCID: PMC5047022 DOI: 10.14740/jocmr2733w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 12/15/2022] Open
Abstract
A 61-year-old woman was admitted to our hospital with an ulcerated palate mass and swelling of the right parotid gland. Incisional biopsy from the hard palate revealed an extranodal marginal zone B-cell lymphoma, also called mucosa-associated lymphoid tissue (MALT) lymphoma. Final diagnosis was MALT lymphoma of the parotid gland with concomitant involvement of an extremely seldom site of involvement: the hard palate. To our knowledge, this report illustrates the first case of MALT lymphoma of the hard palate and parotid gland without an underlying autoimmune disease. Rituximab-based combination regimen (R-CHOP) provided complete remission with total regression of mass lesions at the hard palate and parotid gland. At 44-month follow-up, there is no disease relapse. We adressed the manifestations and management of MALT lymphoma patients with involvement of salivary gland and oral cavity.
Collapse
Affiliation(s)
- Ipek Yonal-Hindilerden
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Fehmi Hindilerden
- Hematology Clinic, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Serkan Arslan
- Radiology Clinic, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nalan Turan-Guzel
- Department of Pathology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Oner Dogan
- Department of Pathology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Meliha Nalcaci
- Division of Hematology, Department of Internal Medicine, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| |
Collapse
|
4
|
Makino Y, Suzuki H, Nishizawa T, Kameyama K, Hisamatsu T, Imaeda H, Mukai M, Hibi T. Ileal Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with a Large-Cell Component That Regressed Spontaneously. Gut Liver 2010; 4:117-21. [PMID: 20479924 DOI: 10.5009/gnl.2010.4.1.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 08/09/2009] [Indexed: 12/20/2022] Open
Abstract
Reported herein is a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the terminal ileum with a large-cell component, which regressed spontaneously. To the best of our knowledge, only five cases of spontaneously regressing MALT lymphoma have been reported in the English-language literature, and all of these cases were low-grade lymphomas. Spontaneous regression of a MALT lymphoma with a high-grade component is very rare. The present case suggests that MALT lymphoma cells have a reversible nature, even in the presence of a high-grade component.
Collapse
Affiliation(s)
- Yohsuke Makino
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Amouri A, Chtourou L, Mnif L, Mdhaffar M, Abid M, Ayedi L, Daoud J, Elloumi M, Boudawara T, Tahri N. [MALT lymphoma of the rectum: a case report treated by radiotherapy]. Cancer Radiother 2008; 13:61-4. [PMID: 19101191 DOI: 10.1016/j.canrad.2008.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 09/11/2008] [Accepted: 11/04/2008] [Indexed: 01/30/2023]
Abstract
The mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, skin and breast. However, colorectal involvement is extremely rare. To our knowledge, only ten cases of primary rectal MALT lymphoma have been reported in the literature. We report a 46-year-old woman with rectal MALT lymphoma, which regressed after radiotherapy. The patient had rectal bleeding. Colonoscopy showed a pseudonodular and ulcerated big fold in the rectum. Microscopic and immunohistologic studies of the biopsy specimen showed typical features of low grade MALT lymphoma. Upper endoscopy showed chronic gastritis with lymphoid follicles but without any infiltration of lymphoma cells. Helicobacter pylori infection was confirmed by histology. No extra-intestinal involvement was found on the staging evaluation, which included computed tomography (CT) of the abdomen, chest, pelvis and a bone marrow biopsy. We attempted to eradicate H. pylori with a 7-day course of omeprazole, amoxycillin, and metronidazole. Eradication was proved successful by endoscopy. Repeated colonoscopy 4 months after the end of treatment showed that the rectal tumor had not regressed. Biopsy specimens confirmed the persistent infiltration of lymphoma cells. The patient was considered to be a non-responder to eradication therapy and was indicated for radiotherapy. He underwent a total of 34 Gy. Complete regression was confirmed by colonoscopic and histologic examination at 2 months after the end of treatment. He was followed up closely with colonoscopy, but no relapse of these lesions was detected after 12 months.
Collapse
Affiliation(s)
- A Amouri
- Service d'hépatogastroentérologie, hôpital Hédi-Chaker, 3029 Sfax, Tunisie.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Foo M, Chao MWT, Gibbs P, Guiney M, Jacobs R. Successful treatment of mucosa-associated lymphoid tissue lymphoma of the rectum with radiation therapy: report of a case. Dis Colon Rectum 2008; 51:1719-23. [PMID: 18633678 DOI: 10.1007/s10350-008-9379-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Accepted: 12/27/2006] [Indexed: 02/08/2023]
Abstract
We report a case of Stage IE mucosa-associated lymphoid tissue lymphoma arising in the rectum, which was successfully treated with radiotherapy. A 60-year-old man had several months of altered bowel habit with rectal bleeding and was found to have a large rectal tumor with no evidence of distant spread. Histologic studies showed this to be a mucosa-associated lymphoid tissue lymphoma. The patient received 45 Gy in 25 fractions with external beam radiotherapy during 5 weeks. The treatment was well tolerated and review at 41 months revealed no evidence of recurrence.
Collapse
Affiliation(s)
- Marcus Foo
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrew's Place, East Melbourne, Victoria, 3002, Australia.
| | | | | | | | | |
Collapse
|
7
|
Ahlawat S, Kanber Y, Charabaty-Pishvaian A, Ozdemirli M, Cohen P, Benjamin S, Haddad N. Primary mucosa-associated lymphoid tissue (MALT) lymphoma occurring in the rectum: a case report and review of the literature. South Med J 2007; 99:1378-84. [PMID: 17233195 DOI: 10.1097/01.smj.0000215855.98512.9d] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast; however, colorectal involvement is rare. To the best of our knowledge, only 30 cases of primary rectal MALT lymphoma have been published in the English language literature, mostly from Japan. A single case has been reported from the US before this report. The most common symptoms ranged from asymptomatic to occult or gross gastrointestinal bleeding. Simultaneous involvement of the cecum or colon was seen in 20% of the patients. Ninety percent of the patients were classified as low grade, Stage 1 at the time of diagnosis. Polypoid lesions were 10-fold more common than ulcerative lesions. Seven patients were reported to have H pylori in the stomach. The majority of the patients underwent surgical or endoscopic resection as a cure; however, controversy exists with regards to antibiotic treatment or observation alone because of unknown etiopathogenesis. Infection with microorganisms other than H pylori has been postulated in the development of rectal MALT lymphoma; however, this hypothesis remains unproven. The overall prognosis of rectal MALT lymphoma appears favorable; however, long-term follow-up data is lacking. Therefore, periodic clinical monitoring should be done in these patients.
Collapse
Affiliation(s)
- Sushil Ahlawat
- Division of Gastroenterology, Department of Pathology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC 20007, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Sakuma H, Okabe M, Yokoi M, Eimoto T, Inagaki H. Spontaneous regression of intraoral mucosa-associated lymphoid tissue lymphoma: molecular study of a case. Pathol Int 2006; 56:331-5. [PMID: 16704497 DOI: 10.1111/j.1440-1827.2006.01967.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma presentation in the oral cavity is very rare. Reported herein is a case of intraoral MALT lymphoma of the minor salivary gland in a 70-year-old woman with Sjogren's syndrome. Unexpectedly, a spontaneous clinically and histologically confirmed regression occurred 1 month after the tumor biopsy for diagnosis. Considering that salivary MALT lymphoma is associated with Sjogren's syndrome and that the chronic inflammation caused by Sjogren's syndrome persisted, it is hypothesized that the tumor clone might be present in the regressed lesion. Minimal residual tumor clone identical with the primary lesion was detected using the polymerase chain reaction (PCR) clonality assay for immunoglobulin heavy chain gene (IgH) rearrangement. No recurrence was clinically evident 38 months after the diagnosis. Spontaneous regression of MALT lymphoma should be examined at the molecular level in addition to clinical and histological evaluations. When minimal residual disease is detected, close follow up is necessary for early detection of the tumor relapse.
Collapse
MESH Headings
- Aged
- Clone Cells/pathology
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/immunology
- Humans
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Neoplasm Regression, Spontaneous/genetics
- Neoplasm Regression, Spontaneous/immunology
- Neoplasm Regression, Spontaneous/pathology
- Neoplasm, Residual/genetics
- Neoplasm, Residual/immunology
- Neoplasm, Residual/pathology
- Oncogene Proteins, Fusion/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Salivary Gland Neoplasms/genetics
- Salivary Gland Neoplasms/immunology
- Salivary Gland Neoplasms/pathology
- Salivary Glands, Minor/immunology
- Salivary Glands, Minor/pathology
Collapse
Affiliation(s)
- Hidenori Sakuma
- Department of Pathology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | |
Collapse
|
9
|
Tanaka S, Ohta T, Kaji E, Kosaka T, Murakami I. EMR of mucosa-associated lymphoid tissue lymphoma of the rectum. Gastrointest Endosc 2003; 57:956-9. [PMID: 12776055 DOI: 10.1016/s0016-5107(03)70039-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shouichi Tanaka
- Department of Gastroenterology, Iwakuni National Hospital, Iwakuni, Japan
| | | | | | | | | |
Collapse
|