Related Subjects:
|Hodgkin Lymphoma
|Non Hodgkin Lymphoma
|Diffuse large B-cell lymphoma
|Intravascular large B-cell lymphoma
|Mantle cell lymphoma
|Marginal Zone Lymphoma
|Gastric (MALT) Lymphoma
|Primary CNS Lymphoma (PCNSL)
|Burkitt's lymphoma
|Follicular Lymphoma
🌿 Gastric MALT lymphoma (Mucosa-Associated Lymphoid Tissue lymphoma) is a type of indolent non-Hodgkin lymphoma that arises in the stomach lining.
It is strongly associated with chronic Helicobacter pylori infection, which drives lymphoid proliferation and malignant transformation.
Unlike gastric adenocarcinoma, MALT lymphoma generally has a better prognosis and may even regress completely with H. pylori eradication.
📖 About
- Most common extra-nodal site for non-Hodgkin lymphoma.
- Usually a B-cell MALT lymphoma linked to chronic H. pylori infection.
- Accounts for ~5% of all gastric malignancies in the UK.
🧬 Pathology
- Indolent, slow-growing non-Hodgkin lymphoma.
- Most often involves the distal stomach.
- Endoscopic appearance: resembles gastritis, benign ulcers, or polyps → can mimic adenocarcinoma.
- Poor prognostic markers: H. pylori-negative disease at presentation or presence of t(11;18)(q21;q21) translocation.
🩺 Clinical Features
- Epigastric/upper abdominal pain.
- Nausea, vomiting, bloating, and dyspepsia.
- Unexplained weight loss.
- Fatigue from anaemia (due to occult GI bleeding).
- Less commonly, haematemesis or melaena.
🔍 Investigations
- Blood tests: FBC, U&E, LFTs, Ca/Phos, LDH, ESR (often nonspecific).
- Endoscopy: May show gastritis-like changes, ulceration, polyps, or mass lesion.
- Biopsy: Required for tissue diagnosis (positive yield ~80%). Multiple samples recommended due to patchy involvement.
- Staging: CT chest/abdomen/pelvis ± PET, bone marrow biopsy in disseminated disease.
🛠️ Management
- ✅ H. pylori eradication (PPI + 2 antibiotics): First-line, highly effective; up to 70–80% regression if H. pylori-positive.
- 💡 Radiotherapy: For localised, H. pylori-negative, or persistent disease.
- 💊 Chemotherapy ± Rituximab (anti-CD20): For advanced or refractory cases.
- 🔪 Surgery: Rare today – reserved for perforation, uncontrolled bleeding, or diagnostic uncertainty.
🛡️ Prevention
- Screen and treat H. pylori in at-risk populations.
- Manage autoimmune conditions (e.g., Sjögren’s, Hashimoto’s) which increase risk of extranodal MALT lymphomas.
📊 Prognosis
- Much better than gastric adenocarcinoma.
- 5-year survival rates >80% with early detection and appropriate therapy.
- H. pylori eradication can be curative in many cases.
📚 Teaching Commentary
💡 Exam pearl: Always test for H. pylori in any patient with gastric MALT lymphoma.
Successful eradication can lead to complete remission without the need for chemo or radiotherapy.
This makes it a unique example of an infection-driven malignancy where antibiotics can be curative.
