Metachronous mucosa-associated lymphoid tissue (MALT) lymphoma and adenocarcinoma of the stomach (case report)

Patient and methods: A 69 year-old woman was diagnosed and successfully treated for MALT lymphoma by conservative (non-surgical) method 4 years earlier. Helicobacter pylori eradication therapy and combined cytostatic treatment was conducted. Close follow-up by repeated upper gastrointestinal endoscopy showed complete regression of lymphoma however, revealed a benign-looking ulcer (1.5cm in diameter) in the distal part of the stomach. Biopsies were obtained from the relatively normal looking mucosa and the margin of the ulcer. Proton-pump inhibitor therapy was initiated. Histopathology of biopsy revealed cellular polymorphism, abnormal mitotic figures and gland formation. A diagnosis of gastric cancer was made. With a diagnosis of gastric cancer, surgical intervention was indicated.

Results: After exploring the abdomen the ulcer was not detected by palpation. An intraoperative endoscopy identified the site of malignant ulcer. Partial gastrectomy (Billroth ll. resection), removal of perigastric lymph-nodes were performed. Postoperative course was uneventful. Histological examination of resected specimen confirmed the diagnosis of gastric cancer (early cancer, intestinal type).

Conclusions: Association of MALT lymphoma and gastric adenocarcinoma in the same patient was more often synchronous than metachronous in nature in earlier reported series. Helicobacter pylori infection may be etiologic factor in the development of both types of gastric malignancies however a possibility of genetic or immunological predisposition can not be excluded. Careful follow-up with repeated upper gastrointestinal endoscopy with biopsy is essential in the management of these conditions. Intraoperative endoscopy may be valuable in detection of small lesions.