Ocular adnexal lymphoma and Helicobacter pylori gastric infection

Abstract

There is a causal association between Helicobacter pylori (Hp) gastric infection and the development of gastric MALT lymphoma. In contrast, the link between Hp gastric infection and the development of extragastric lymphoma has not been thoroughly investigated. We, therefore, studied the prevalence of gastric Hp infection at initial diagnosis of ophthalmologic and nonophthalmologic extragastric lymphoma patients. Three cohorts of patients were studied: a first one of 83 patients with OAL, a second one of 101 patients with extraophthalmologic extragastric lymphoma, and a third one of 156 control individuals (control) without malignant lymphoma. Gastric Hp infection was investigated by histopathological analysis and Hp-specific PCR assay on gastric biopsy tissue samples. We found gastric Hp infection in 37 OAL patients (45%), in 25 extraophthalmologic extragastric lymphoma cases (25%), and in 18 controls individuals (12%) (P < 0.0001 OAL/C and P < 0.01 OAL/extra-OAL cases). Gastritis was found in 51% and 9% of Hp-positive and Hp-negative lymphoma patients, respectively (P < 10 24 ). Gastric Hp infection only correlated with MALT/LPL lymphoma (P 5 0.03). There is a significant association between gastric Hp infection and MALT/LPL OAL. This suggests a novel mechanism of indirect infection-associated lymphomagenesis whereby chronic local antigen stimulation would lead to the emergence of ectopic B-cell lymphoma. Am. J. Hematol. 85:645-649, 2010. V

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“…In conclusion, the work of Decaudin et al [24] remind us that at least two pathways appear to be involved in the development of EMZL OAL, and in doing so, also propose a third mechanism. The first lymphoma genetic pathway involves chronic inflammation (autoimmune disease or bacterial infections) at the affected site, resulting in an uncontrolled chronic stimulation of B-cells, favoring the occurrence of as yet poorly-understood secondary genetic and epigenetic alterations.…”

“…It would have been of interest here to have details to the treatment modalities of the OAL patients, which is known to vary considerably between centers. The data presented here by Decaudin et al [24] would suggest that OAL patients should be examined for gastric H. pylori infection following lymphoma diagnosis, and that, if positive, antibacterial treatment for Helicobacter could possibly result in the disappearance of an OAL EMZL if treated early enough, as seen in gastric MALT lymphomas. A validatory multicentre prospective trial, possibly using the newly-proposed TNM-based staging system for OAL [28], which allows for better definition of tumor size and location within the ocular adnexa, would be required to test this hypothesis.…”

“…In this issue of the American Journal of Hematology, Decaudin et al [24] have examined a large series of gastric biopsies for H. pylori in three cohorts of patients: (A) patients with OAL (n 5 83); (B) patients with extra-gastric and extra-ophthalmologic lymphoma (n 5 101); and (C) patients with no clinical evidence of lymphoma (controls; n 5 156). Gastric H. pylori infection was investigated by means of histopathological analysis and H. pylori-specific polymerase chain reaction (PCR) assay on gastric biopsy tissue samples, and was demonstrated in 45%, 25% and 12% of patients in groups A, B, and C, respectively.…”

“…To support their hypothesis, however, the authors point out the frequent bilateral involvement of OAL EMZL [25][26][27] and a relatively high incidence of blepharitis in patients with gastric H. pylori [23]. Decaudin et al [24] also propose that, like the autoantigen H(1)K(1)-ATPase, expressed by the gastric epithelium, the lacrimal gland and the gastric may share common epitopes, which could be targets for autoimmune disease. Animal models for OAL, which have yet to be established, would be of use in understanding the interplay of these inflammatory processes.…”

“…Another merit of the paper by Decaudin et al [24] is represented by the attempt to correlate gastric H. pylori infection with the clinical features of the OAL-i.e., the location and Ann Arbor Stage of the tumor, the International Prognostic Index score and the clinical course. The data would suggest that the gastric H. pylori infection detected at the initial diagnosis of lymphoma had no impact on diseasefree survival and the overall survival of the OAL and extraophthalmologic lymphoma patients.…”