Diagnosing MALT Gastric Lymphoma in Gastroenterologist’s Practice, a Clinical Observation

Abstract

Aim. A clinical case description to highlight challenges in diagnosing MALT lymphoma presented in infiltrative ulcer-ative lesions.Key points. A 60-yo patient was admitted to the Loginov Moscow Clinical Scientific Centre with epigastric pain and an 18 kg weight loss over past 4 months. A history of repeated outpatient endoscopic examinations revealing subse-quently ulcerative and infiltrative ulcerative gastric lesions of unestablished origin. A complex examination combin-ing oesophagogastroduodenoscopy (OGDS), endosonography (EUS), multislice computed tomography (MSCT), morphological and immunohistochemical (IHC) assays elicited the MALT gastric lymphoma IIE stage involving para-gastric and intraperitoneal lymph nodes. The first treatment stage included line-1 eradication therapy, rabeprazole 20 mg x 2 times a day, amoxicillin 1000 mg x 2 times a day, clarithromycin 500 mg x 2 times a day, bismuth tripotas-sium dicitrate 240 mg x 2 times a day — for 14 days. Accounting for the process prevalence and stage, six courses of R-CHOP polychemotherapy (PCT) were ordered by haematologist.Conclusion. This observation demonstrates a targeted-biopsy endoscopic examination followed by morphological, IHC, EUS (for invasion depth) and MSCT (for process advancement) assays to be decisive in differential diagnosis of ulcerative and infiltrative ulcerative gastric lesions.

Keywords

• malt gastric lymphoma
• h. pylori
• eradication therapy conflict of interest: the authors declare no conflict of interest