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Korean J Gastroenterol  <  Volume 74(6); 2019 <  Articles

Korean J Gastroenterol 2019; 74(6): 304-313  https://doi.org/10.4166/kjg.2019.74.6.304
Diagnosis and Treatment of Gastric Mucosa-associated Lymphoid Tissue Lymphoma
Eun Jeong Gong and Kee Don Choi1
Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine1, Seoul, Korea
Correspondence to: Kee Don Choi, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-5813, Fax: +82-2-476-0824, E-mail: keedon@amc.seoul.kr, ORCID: https://orcid.org/0000-0002-2517-4109
Received: October 24, 2019; Revised: November 11, 2019; Accepted: November 15, 2019; Published online: December 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients’ preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.
Keywords: Diagnosis; Helicobacter pylori; Lymphoma, B-cell, marginal zone; Therapeutics


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