A 71 year old lady was referred by her GP for an urgent (“2 week wait”) gastroscopy. She gave a several week history of dyspepsia after meals. There was no weight loss or vomiting. She was not on a PPI. Endoscopy showed an ulcer in the lower stomach (see video). The CLO test was positive.
The histology showed extranodal marginal zone B cell lymphoma/ MALT lymphoma; no evidence of high grade transformation.
The endoscopic features of the disease is very varied, often mimicking benign disease, such as erosions, multifocal gastritis or other types of malignancies, such as gastric adenocarcinoma. A frequent and typical feature is the presence of gastric nodularity or enlarged folds located at the antrum or body of the stomach. Another endoscopic feature is ulceration with elevated margins or a protrusion.
A metanalysis by Zullo et al, evaluating 38 manuscripts comprising 2000 patients, showed that MALT lymphomas were more frequently localised in the gastric antrum and body (60%-70% of cases )and presented the following endoscopic feature:
9.7% exophytic mass;
52.1% ulcerative pattern,
1% petechial haemorrhage,
12.7% normal/hyperemic mucosa.
The endoscopic pattern differ between high-grade and low-grade lymphomas. High grade lymphomas are more likely to present with exophytic mass. Low-grade lymphomas present more frequently with petechial haemorrhages and normal/hyperemic mucosa[.
Zullo A, Hassan C, Andriani A, Cristofari F, Cardinale V, Spinelli GP, Tomao S, Morini S. Primary low-grade and highgrade gastric MALT-lymphoma presentation. J Clin Gastroenterol 2010; 44: 340-344 [PMID: 19745757 DOI: 10.1097/ MCG.0b013e3181b4b1ab]
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