Gastric MALT lymphoma: clinical characteristics and prevalence of H. pylori infection in a series of 37 cases

Abstract

Objective: to perform a retrospective review of the clinical characteristics and prevalence of H. pylori infection in patients with gastric MALT lymphoma diagnosed in our hospital during the last 15 years.Methods: patients with gastric MALT lymphoma diagnosed in our hospital during the last 15 years were retrospectively included. Demographic, clinic, analytic, endoscopic, and histological variables were reviewed. The extension study, the staging classification, and the presence of H. pylori infection were assessed.Results: thirty-seven patients with gastric MALT lymphoma were identified. Mean age was 61 years, with 62% of males. The most common presentation symptom was dyspepsia (76%), followed by digestive bleeding (11%) and constitutional syndrome (8%). At endoscopy, erosive lesions were identified in 41%, and proliferative or exophytic lesions in 43%. Most lymphomas were classified as low-grade (68%). The stage distribution was EI for 56%, EII for 13%, EIII for 3%, and EIV for 28%. The prevalence of H. pylori infection (histology in all cases, rapid urease test in 19%, and 13 C-urea breath test in 24%) was 46%. When only lowgrade lymphomas in stage EI were considered, H. pylori prevalence increased to 55%. When H. pylori infection was evaluated by 13 C-urea breath testing (in addition to histology), the prevalence of H. pylori infection increased to 78%.Conclusions: it is probable that the reduced H. pylori prevalence found in some studies, as in ours, could be explained by false-negative results obtained when only one diagnostic method was used. Therefore, at least two (invasive) diagnostic methods should be performed. Furthermore, the performance of a non-invasive diagnostic method (such as a 13 C-urea breath test) before the exclusion of H. pylori infection should be considered.

Primary gastric mucosa associated lymphoid tissue lymphoma: Clinical data predicted treatment outcome

“…Anemia, as a result of erythrocytopoiesis suppression in malignant disease and due to BM infiltration, had a negative influence on disease outcome as well as high Ann Arbor modified clinical stage. Our findings are in agreement with prognostic factor analysis in described literature data [29,30] . In contrary to persistence of disease, the basic goal would be prevention of MALT lymphoma appearance.…”

“…Therefore, EUS has a much higher sensitivity in distinguishing stage IE from stage IIE1 lymphoma, compared with CT scan. Furthermore, with analysis of the response data according to depth of infiltration, the overall response rate was highest for mucosa stage IE1 and then decreased with the depth of gastric wall infiltration [23,[27][28][29] . Among all examined prognostic factors, the IPI score was the most powerful prognostic factor for OS, together with ESR and platelet number in the Cox hazard regression model (P = 0.0039).…”

Prevalencia de la infección por Helicobacter pylori en el linfoma MALT gástrico: una revisión sistemática

“…En la presente revisión sistemática, en la que se han incluido 1.844 pacientes con linfoma MALT, se calculó una prevalencia media de la infección por H. pylori del 79%, una cifra relativamente elevada. No obstante, los porcentajes comunicados por los diferentes autores son notablemente discordantes, pues oscilan entre casi el 100% (16,20,39) en algunos estudios y menos de 50% (35,36,45) en otros.…”

Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma

“…These findings suggest that the small prevalence found in some studies may result from false negative results on using only one test (particularly a test with low sensitivity), and suggest that at least two tests should be employed to reliably identify H. pylori . In other words, a negative result with only one diagnostic test should not rule out H. pylori infection, and negativity in at least two diagnostic modalities should be required to definitely consider a patient as non‐infected 6, 36 …”