Magnified endoscopic findings of gastric low-grade mucosa-associated lymphoid tissue lymphoma

We report magnified endoscopic findings of gastric low-grade mucosa-associated lymphoid tissue (MALT) lymphoma before and after anti-tumor therapies. Magnifying chromoendoscopy with crystal violet was carried out in nine patients with low-grade MALT lymphoma of the gastric corpus with Helicobacter plyori infection. A Wotherspoon histologic score of 5 was used as the criterion to make the histopathologic diagnosis. On conventional endoscopy, each patient was classified as having a superficial spreading type of the lymphoma, varying from gastritis to adenocarcinoma-like appearance. Anti-H. pylori treatment was successful in all cases. Complete regression was observed in six of the nine patients with MALT lymphoma and no regression was seen in three during the median follow-up of 12 months. Magnified endoscopic findings consisted exclusively of irregular and destroyed gastric pits in the lymphoma lesions. Histopathologic examination of targeted biopsies obtained from the affected mucosa with the abnormal pit pattern revealed the characteristic features of lymphoepithelial lesions and centrocyte-like cell infiltration. In six patients who underwent repeat magnifying endoscopy at 6 months or more after anti-tumor therapies (five with complete regression following anti-H. pylori therapy and one who had been treated with radiation), the abnormal pits appeared to have returned to normal. Magnifying endoscopy can reliably identify irregular and destructive pit patterns in the lymphoma lesions, and aid the prediction of histopathlogic regression.

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