Endoscopic Findings of Gastric Extranodal Marginal Zone B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma

Sang Kil Lee

doi:10.5946/ce.2017.014

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Commentary Endoscopic Findings of Gastric Extranodal Marginal Zone B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma: Sang Kil Lee; Clinical Endoscopy 2017;50(1):1-2.
DOI: https://doi.org/10.5946/ce.2017.014
Published online: January 30, 2017

Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea

Correspondence: Sang Kill Lee, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2272, Fax: +82-51-244-8180, E-mail: SKLEE@yuhs.ac

• Received: December 15, 2016 • Revised: January 18, 2017 • Accepted: January 18, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

See the article "Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission" on page 51.

See "Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission" by Chang Min Lee, Dong Ho Lee, Byung Kyu Ahn, et al., on page [Related article:] 51-57.

Approximately 360,000 new cases of non-Hodgkin’s lymphoma were diagnosed worldwide in 2014. Of these, approximately 7% were diagnosed with mucosa-associated lymphoid tissue (MALT) lymphoma [1]. Gastric extranodal marginal zone B-cell MALT lymphoma accounts for 1%–7% of malignant gastric tumors and 60%–75% of gastrointestinal MALT lymphomas [2].

Gastric MALT lymphoma shows various endoscopic findings. The structure and function of gastric MALT are similar to those of Peyer’s patches in the terminal ileum [3]. Gastric MALT originates in subepithelial layers, usually in the stromal space, and grows under the normal gastric foveolar glands [4]. Thus, both mucosal and submucosal lesions can be found on endoscopic examination. Therefore, the histologic diagnosis of lymphoma is often unexpected, even to an experienced endoscopist.

Taal et al. attempted to classify the endoscopic findings in gastric MALT lymphoma into several categories [5]. Thereafter, several classification systems based on gross morphology were suggested [6,7]. However, there have been no generally accepted classification criteria, because the clinical implications of endoscopic categorization of gastric MALT lymphoma are still unclear.

Advanced stage, gene translocation t(11;18) (q21;q21), and non-responder (no change) MALT lymphomas that persist after successful Helicobacter pylori eradication are associated with poor prognosis [8-10]. In addition to those factors, Lee et al. in this issue of Clinical Endoscopy, concluded that the endoscopically defined polypoid type is associated with poor prognosis, and is characterized by a longer duration to complete response (CR), with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types [11]. However, caution is needed when interpreting the results of this study. Even though the authors stated that there was no significant colinearity between endoscopic findings, Ann Arbor stage, and/or treatment, one of the three variables could be a potential confounding factor, as the authors suggested. With reference to their data summarized in the table, polypoid lesions are more likely to be diagnosed at an advanced Ann Arbor stage, as compared to diffuse infiltration or ulceration types.

In a review of previous reports, Yokoi et al. suggested that the pathogenesis of polypoid gastric MALT lymphoma has little association with H. pylori infection [7]. However, the results of this study are different from those in Yokoi’s report. Thus, it is still uncertain whether there is a reasonable explanation for a causal relationship between polypoid gastric MALT lymphoma and poor prognosis. We hope that a follow-up study can demonstrate a correlation between polypoid MALT lymphoma and poor prognostic factors, such as nodal involvement [12] or plasmacytic differentiation [13].

Endoscopic ultrasonography (EUS) is essential for T-staging in gastric MALT lymphoma. EUS should be emphasized in the staging work-up for gastric MALT lymphoma. Recently, the European Society for Medical Oncology guideline for gastric MALT lymphoma recommended EUS to evaluate regional lymph nodes and gastric wall infiltration (level of evidence III, grade of recommendation A) [1]. Although this is a major limitation of a retrospective study, only about one-third of patients were examined by EUS.

Nevertheless, it is interesting and commendable that the authors classified gastric MALT lymphoma using morphological categorization. As endoscopic devices are being developed, the description of endoscopic morphology of gastric lymphoma is now more detailed. A recent study focused on the diagnosis of gastric lymphoma based on endoscopic morphology [14]. Moreover, Nonaka et al. suggested that narrow-band imaging magnifying endoscopy may be useful not only in the diagnosis but also in the evaluation of the response to eradication therapy [15].

Nonetheless, there is insufficient evidence for an explanation of the distinct features of polypoid gastric MALT lymphoma. We do not know the causes of any morphological differences, but an ongoing study will resolve this question someday.

Conflicts of Interest: The author has no financial conflicts of interest.

REFERENCES

1. Zucca E, Copie-Bergman C, Ricardi U, Thieblemont C, Raderer M, Ladetto M. Gastric marginal zone lymphoma of MALT type: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24 Suppl 6:vi144–vi148.Article PubMed
2. Bertoni F, Coiffier B, Salles G, et al. MALT lymphomas: pathogenesis can drive treatment. Oncology (Williston Park) 2011;25:1134–1142; 1147.PubMed
3. Neyt K, Perros F, GeurtsvanKessel CH, Hammad H, Lambrecht BN. Tertiary lymphoid organs in infection and autoimmunity. Trends Immunol 2012;33:297–305.Article PubMed PMC
4. Ferreira M, Domingues RG, Veiga-Fernandes H. Stroma cell priming in enteric lymphoid organ morphogenesis. Front Immunol 2012;3:219.Article PubMed PMC
5. Taal BG, den Hartog Jager FC, Tytgat GN. The endoscopic spectrum of primary non-Hodgkin’s lymphoma of the stomach. Endoscopy 1987;19:190–192.Article PubMed PDF
6. Kolve M, Fischbach W, Greiner A, Wilms K. Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkin’s lymphoma. German gastrointestinal lymphoma study group. Gastrointest Endosc 1999;49(3 Pt 1):307–315.Article PubMed
7. Yokoi T, Nakamura T, Kasugai K, et al. Primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma with polypoid appearance. Polypoid gastric MALT lymphoma: a clinicopathologic study of eight cases. Pathol Int 1999;49:702–709.Article PubMed
8. Li X, Wang X, Zhan Z, Zhang L, Sun B, Zhang Y. Evaluation of the clinical characteristics, management, and prognosis of 103 patients with gastric mucosa-associated lymphoid tissue lymphoma. Oncol Lett 2016;11:1713–1718.Article PubMed PMC
9. Liu H, Ruskon-Fourmestraux A, Lavergne-Slove A, et al. Resistance of t(11;18) positive gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication therapy. Lancet 2001;357:39–40.Article PubMed
10. Radaszkiewicz T, Dragosics B, Bauer P. Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue: factors relevant to prognosis. Gastroenterology 1992;102:1628–1638.Article PubMed
11. Lee CM, Lee DH, Ahn BK, et al. Correlation of endoscopic findings of gastric mucosa-associated lymphoid tissue lymphoma with recurrence after complete remission. Clin Endosc 2017;50:51–57.Article PubMed PMC PDF
12. Ruskoné-Fourmestraux A, Lavergne A, Aegerter PH, et al. Predictive factors for regression of gastric MALT lymphoma after anti-Helicobacter pylori treatment. Gut 2001;48:297–303.Article PubMed PMC
13. Park S, Ahn S, Hong M, Ko YH. Increased plasmacytic differentiation in gastric mucosa-associated lymphoid tissue lymphomas: Helicobacter pylori eradication response and IgG4+ plasma cell association. Hum Pathol 2017;59:113–119.Article PubMed
14. Malikhova OA, Poddubnyĭ BK, Poddubnaia IV, Moskalenko OA, Kontsevaia A. [Endoscopic criteria for diagnosis of various macroscopic variants of non-Hodgkin’s gastric lymphoma]. Eksp Klin Gastroenterol 2010;(9):33–37.
15. Nonaka K, Ohata K, Matsuhashi N, et al. Is narrow-band imaging useful for histological evaluation of gastric mucosa-associated lymphoid tissue lymphoma after treatment? Dig Endosc 2014;26:358–364.Article PubMed

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Endoscopic Findings of Gastric Extranodal Marginal Zone B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma

Clin Endosc. 2017;50(1):1-2. Published online January 30, 2017

DOI: https://doi.org/10.5946/ce.2017.014

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Endoscopic Findings of Gastric Extranodal Marginal Zone B-Cell Mucosa-Associated Lymphoid Tissue Lymphoma