A rare case of gastric MALT lymphoma resistant to multiple treatment regimens
- Gehong Dong1,2,
- Yuanxue Huang1,
- Qingguo Yan1,3,
- Estelle Chanudet1,
- Hongtao Ye1,
- Hongxiang Liu4,
- Peter G Isaacson5,
- Manuel Rodriguez-Justo5,
- Ming-Qing Du1,4
- 1Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, UK
- 2Department of Pathology, Health Science Centre, Beijing University, Beijing, China
- 3State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, China
- 4Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- 5Department of Pathology, University College Hospital, London, UK
- Correspondence to Professor Ming-Qing Du, Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Level 3 Lab Block, Box 231, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK; mqd20{at}cam.ac.uk
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Contributors GD performed CGH; YH and QY carried out mutation analyses; EC, HY and HL preformed FISH; PGI and MR-J made histological diagnosis and provided clinical data; M-QD supervised the study and wrote the manuscript. All authors had commented on the manuscript and approved its content.
In general, patients with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) run an indolent clinical course and respond favourably to treatment. For example, ∼70% of gastric MALT lymphomas are cured by Helicobacter pylori eradication alone. The remaining cases, which commonly carry t(11;18)(q21;q21)/API2-MALT1 or t(1;14)(p22;q32)/BCL10-IGH and do not respond to H pylori eradication, can be effectively treated by radiotherapy or chemotherapy with and without rituximab. Here, we report a case of gastric MALT lymphoma, which showed an aggressive clinical course and resisted multiple regimens of chemotherapy plus rituximab.
The patient was in mid-50s and presented with night sweats, weight loss, left pleural effusion, erythema nodosum and a chest wall mass. Full blood count was normal with the exception of a slightly reduced haemoglobin level (9.4 g/dl). Lactate dehydrogenase was raised (670 units/l). Endoscopy showed gastric mucosa thickening. Biopsies of the gastric body and antral mucosa displayed a heavy infiltration by small lymphocytes with irregularly shaped nuclei and scanty cytoplasm (figure 1A). These lymphocytes invade gastric glands and form extensive …
