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• W2978633211 abstract "A 51-year-old African American female with hypertension and a 30 pack year tobacco history presented with a 1 year history of right upper quadrant abdominal pain upon eating or drinking. She denied personal or family history of gastrointestinal malignancy. She had no B-symptoms or pruritus. Examination was unremarkable except for mild pallor and epigastric tenderness. Initial upper GI series and esophagogastroduodenoscopy (EGD) findings were suggestive of nodular gastritis thus raising a suspicion for H. pylori gastritis, for which she was empirically treated with triple regimen. Preliminary gastric biopsies showed extensive lymphoplasmacytic infiltrate within the lamina propria, suspicious for a lymphoproliferative process with no H. pylori or intestinal metaplasia. This lesion was finally confirmed to be CD20+ gastric MALT lymphoma. EGD with biopsy 3 months after trial of H. pylori eradication showed persistent gastric MALT lymphoma. Whole body CT scan with contrast, PET/CT and bone marrow biopsy did not reveal any distant metastasis or marrow involvement. Bone marrow staining was, however, suggestive of iron deficiency anemia. She was successfully treated with a total of 3060-cGy radiation therapy without interruption for Stage IA primary gastric MALT lymphoma with complete symptom resolution. Repeat EGD with biopsies at 3 and 12 months post radiation therapy showed no evidence of residual gastric MALT lymphoma. H. pylori is the decisive pathogenic factor for gastric MALT lymphoma in >95% of patients. 80% of patients with H. pylori positive gastric MALT lymphomas achieve remission after H. pylori eradication therapy, making this the first-line therapy. However, experience with eradication therapy in H. pylori negative gastric MALT lymphomas, such as our patient, is limited to a few case reports and small clinical series. The 2015 NCCN guidelines recommend radiation therapy as the preferred treatment forH. pylori negative gastric MALT lymphoma. However, recent studies have suggested H. pylori eradication could be performed as a primary therapy regardless of H. pylori status, raising a treatment dilemma. Given the indolent nature of localized gastric MALT lymphoma, H. pylori eradication therapy should still be tried irrespective of H. pylori status, before resorting to aggressive, costly, and potentially more toxic therapies such as radiation and chemotherapy." @default.
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• W2978633211 date "2015-10-01" @default.
• W2978633211 modified "2023-09-27" @default.
• W2978633211 title "Helicobacter pylori-Negative Gastric MALT Lymphoma: A Treatment Dilemma" @default.
• W2978633211 doi "https://doi.org/10.14309/00000434-201510001-01228" @default.
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