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Magenlymphome vom MALT-Typ

Pathologie, Pathogenese, Diagnostik und Therapie

Gastric MALT-type lymphoma

Pathology, pathogenesis, diagnostics and therapy

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Zusammenfassung

In der Entstehung des Magenlymphoms vom MALT-Typ („Mucosa-Associated Lymphoid Tissue“) spielt die Helicobacter- (H.-)pylori-Infektion die zentrale Rolle. Sie führt zum Einwandern der B-Lymphozyten in die Magenschleimhaut und stimuliert zusammen mit Antigenen bzw. Autoantigenen die Proliferation der B-Lymphozyten, die letztlich den Boden für die neoplastische Transformation darstellt. Das histologische Bild des MALT-Lymphoms weist eine ausgeprägte Ähnlichkeit zum Aufbau des physiologischen MALT auf. Wichtigstes diagnostisches Kriterium ist dabei die Invasion des Magenepithels mit Ausbildung so genannter lymphoepithelialer Läsionen. Zytologisch zeigt das MALT-Lymphom meistens ein zentrozytoides oder monozytoides Erscheinungsbild. Immunhistochemische Untersuchungen sind hilfreich zur definitiven Lymphomdiagnose und zur Abgrenzung von anderen kleinzelligen Lymphomen im Magen. Der Phänotyp des MALT-Lymphoms ist identisch zu den nichtneoplastischen B-Zellen der Marginalzone (CD20+, CD5–, CD10–, CD23–). Die Therapie erfolgt individualisiert in Abhängigkeit von histologischem Typ und Stadium. Das Therapieziel besteht heute in der Heilung des Lymphoms und kann durch eine H.-pylori-Eradikation, Strahlentherapie, Chemotherapie, Operation oder durch deren Kombination erreicht werden.

Abstract

Helicobacter pylori infection plays a central role in the development of gastric MALT-type (mucosa-associated lymphoid tissue) lymphoma. Infection results in chronic H. pylori gastritis and stimulates together with antigens or autoantigens proliferation of B-lymphocytes which is the basis for the neoplastic transformation. Histology of MALT-type lymphoma is architecturally similar to the physiological MALT. Invasion and destruction of the gastric epithelium with development of so-called lympho-epithelial lesions is the most important diagnostic criterion. Cytologically MALT-lymphoma resembles centrocytes and monocytes. For definitive lymphoma diagnosis and for the differential diagnosis from other small cell lymphomas in the stomach immunohistochemistry can be helpful. The phenotype of MALT-type lymphoma is identical to non-neoplastic B-lymphocytes of the marginal zone (CD20+, CD5-, CD10- and CD23-). Individual therapy is strongly dependent from histological type and lymphoma stadium. Therapy modalities are H. pylori eradication, radiochemotherapy, surgery or a combination of these. Aim of the therapy is the complete lymphoma regression and cure of the disease.

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  1. Institut für Pathologie, Klinikum Aschaffenburg, Am Hasenkopf, 63704, Aschaffenburg, Deutschland

    M. Eck

  2. Medizinische Klinik II, Klinikum Aschaffenburg, Aschaffenburg, Deutschland

    W. Fischbach

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  1. M. Eck
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  2. W. Fischbach
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Correspondence to M. Eck.

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Eck, M., Fischbach, W. Magenlymphome vom MALT-Typ. Pathologe 31, 188–194 (2010). https://doi.org/10.1007/s00292-009-1269-2

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