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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 …