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Gastric MALT lymphoma with t(14;18)(q32;q21) involving IGH and BCL2 genes that responded to Helicobacter pylori eradication
  1. Shotaro Nakamura1,
  2. Hongtao Ye2,
  3. Chris M Bacon2,
  4. Hongxiang Liu2,
  5. Alison Goatly2,
  6. Takayuki Matsumoto3,
  7. Hideki Koga3,
  8. Junji Umeno3,
  9. Yutaka Ohji4,
  10. Takashi Yao4,
  11. Tsukasa Nakahara5,
  12. Mitsuo Iida6,
  13. Ming-Qing Du7
  1. 1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  2. 2Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, UK
  3. 3Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  4. 4Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  5. 5Department of Internal Medicine, Kyushu Central Hospital, Fukuoka, Japan
  6. 6Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
  7. 7Division of Molecular Histopathology, Department of Pathology, University of Cambridge, UK
  1. Dr S Nakamura, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; shomaka{at}intmedz.med.kyushu-u.ac.jp

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Four recurrent chromosomal translocations are recognised in mucosa-associated lymphoid tissue (MALT) lymphomas: t(11;18)/API2-MALT1, t(1;14)/IGH-BCL10, t(14;18)/IGH-MALT1 and t(3;14)/IGH-FOXP1. In contrast, t(14;18)/IGH-BCL2, the genetic hallmark of follicular lymphoma, has been observed in only rare cases of MALT lymphoma. Oesophagogastroduodenoscopy revealed an ulcer in erythematous granular mucosa at the gastric corpus in a 55-year-old man. A diagnosis of MALT lymphoma was made on the basis of typical histological and immunohistochemical features of biopsy specimens: a diffuse infiltrate of centrocyte-like cells surrounding reactive lymphoid follicles and forming lymphoepithelial lesions, and a CD20+, IgD−, CD5−, CD10−, Bcl6−, cyclinD1− immunophenotype. Four months after the successful eradication of Helicobacter pylori, there was endoscopic regression with probable minimal residual disease detected by biopsy, but histological relapse was recognised 12 months after eradication. Interphase fluorescence in situ hybridisation revealed t(14;18)/IGH-BCL2, but not the translocations typically seen in MALT lymphoma. This is the first report of a gastric MALT lymphoma with t(14;18)/IGH-BCL2 that responded to H pylori eradication.

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is genetically characterised by the recurrent translocations t(11;18)(q21;q21)/API2-MALT1, t(1;14)(p22;q32)/BCL10-IGH, t(14;18)(q32;q21)/IGH-MALT1 and t(3;14)(p14;q32)/FOXP1-IGH.1 2 Recent evidence suggests that at least some of these translocations may be associated with distinct clinicopathological features.1 3 The t(14;18)(q32;q21)/IGH-BCL2 is found in the majority of follicular lymphomas and some diffuse large B-cell lymphomas.4 However, MALT lymphomas carrying this translocation are extremely rare and their clinical features are virtually unknown.

Case report

A 55-year-old asymptomatic man underwent oesophagogastroduodenoscopy (OGD) as screening for gastric carcinoma. OGD revealed an open ulcer with surrounding granular erythematous mucosa in the upper corpus (fig 1A …

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