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Stage IV intramucosal gastric marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type

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Abstract

A 45-year-old woman with no symptoms underwent upper gastrointestinal endoscopy. A discolored area was noted at the greater curvature of the gastric upper body. Endoscopic ultrasonography demonstrated thickening of the second sonographic layer indicating that the depth of invasion was confined to the mucosa. A urea breath test and anti-Helicobacter pylori antibody test were negative. A computed tomography scan showed a consolidation at the right lung. Gastric biopsy and transbronchial lung biopsy (TBLB) demonstrated a monotonous proliferation of atypical small lymphocytes. A diagnosis of gastric marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type (MALT lymphoma) was made. The clinical stage was stage IV. A genetic analysis showed rearrangement of the joining region of the immunoglobulin heavy chain gene and identical clones in both lesions. An API2–MALT1 fusion gene was detected in the gastric lesion. After H. pylori eradication treatment, combination treatment with rituximab plus CHOP (R-CHOP) was performed; 6 months later an endoscopy revealed complete disappearance of the lesion. Multiple gastric biopsies showed no infiltrating atypical lymphocytes. Similarly, the lesion in the lung showed complete remission (CR) on CT and TBLB. This report shows that a gastric MALT lymphoma located in the mucosa and disseminated to the lung maintained CR by R-CHOP.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Masahiko Ohtaka, Tadashi Sato, Shouji Kobayashi, Ryouta Sueki, Tatsuya Yamaguchi, Tomoyoshi Uetake, Hiroyuki Ohtsuka & Nobuyuki Enomoto

  2. Department of Hematology, University of Yamanashi, Chuo, Japan

    Noriaki Iwao & Keita Kirito

Authors
  1. Masahiko Ohtaka
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  2. Tadashi Sato
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  3. Shouji Kobayashi
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  7. Hiroyuki Ohtsuka
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  10. Nobuyuki Enomoto
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Correspondence to Masahiko Ohtaka.

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Ohtaka, M., Sato, T., Kobayashi, S. et al. Stage IV intramucosal gastric marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type. Clin J Gastroenterol 6, 127–133 (2013). https://doi.org/10.1007/s12328-013-0374-1

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  • DOI: https://doi.org/10.1007/s12328-013-0374-1

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