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A rare case of gastric MALT lymphoma resistant to multiple treatment regimens
  1. Gehong Dong1,2,
  2. Yuanxue Huang1,
  3. Qingguo Yan1,3,
  4. Estelle Chanudet1,
  5. Hongtao Ye1,
  6. Hongxiang Liu4,
  7. Peter G Isaacson5,
  8. Manuel Rodriguez-Justo5,
  9. Ming-Qing Du1,4
  1. 1Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Cambridge, UK
  2. 2Department of Pathology, Health Science Centre, Beijing University, Beijing, China
  3. 3State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, China
  4. 4Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  5. 5Department of Pathology, University College Hospital, London, UK
  1. 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}

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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 …

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  • Funding The work in M-QD's laboratory is supported by research grants from the Leukaemia & Lymphoma Research UK, the Elimination of Leukaemia Fund, UK, and the Lady Tata Memorial Trust. GD was supported by a fellowship from the China Scholarship Council. QY was supported by a research grant from the National Natural Science Foundation of China (No.30770903).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.