Unusual Treatment of Gastric Mucosa Associated Lymphoid Tissue Lymphoma Unresponsive to <i>Helicobacter pylori</i> Eradication

Kim, Woo Tae; Park, Won Seok; Kang, Sang Bum; Nam, Soon Woo; Lee, Dong Soo; Lee, Seung Woo; Kim, Yeon Soo; Kim, Jong Ok

doi:2013.13.2.109

Korean J Helicobacter Up Gastrointest Res > Volume 13(2); 2013 > Article

Case Report

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2013;13(2):109-113.
DOI: https://doi.org/10.7704/kjhugr.2013.13.2.109 Published online June 10, 2013.

Unusual Treatment of Gastric Mucosa Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication

Woo Tae Kim, Won Seok Park, Sang Bum Kang, Soon Woo Nam, Dong Soo Lee, Seung Woo Lee, Yeon Soo Kim, Jong Ok Kim

¹Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Korea. grandbleu@catholic.ac.kr
²Department of Pathology, College of Medicine, The Catholic University of Korea, Daejeon, Korea.

Abstract

The connection between Helicobacter pylori and mucosa-associated lymphoid tissue (MALT) lymphoma is well established. H. pylori eradication is the initial treatment for MALT lymphoma. However, in H. pylori negative cases or unresponsive patients after successful eradication, radiation, systemic therapies, and surgical resection should be considered. Also local treatment modalities such as endoscopic mucosal resection (EMR) may be a therapeutic option in cases of low grade, localized MALT lymphoma. Herein, we report a case of a 53-year-old man who had a persistent endoscopic mass and tumor cells on histology for 5 months despite H. pylori eradication. Because of no early response to H. pylori eradication, the possibility of the presence of a high-grade lymphoma component, the proximal location of the tumor, and the exophytic nature of the tumor, we decided to perform EMR for complete resection. After EMR, the patient remained in complete remission throughout the 15-month follow up. In our case, endoscopic resection could lead to a more rapid complete remission. Therefore, we suggest that endoscopic resection may be a useful option for low-grade exophytic-type gastric MALT lymphoma treatment with no response to H. pylori eradication.

Key Words: Lymphoma, B-cell, Marginal zone; Endoscopy