Clinical Course of Patients with Gastric MALT Lymphoma after Eradication of Helicobacter pylori―The Value of Clinical Typing Based on Endosonographic Findings Hiroshi Suekane 1 , Mitsuo Iida 1 , Shotaro Nakamura 2 1Division of Gastroenterology, Department of Medicine, Kawasaki Medical School 2The Second Department of Internal Medicine, Kyushu University Hospital Keyword: 胃MALTリンパ腫 , 超音波内視鏡 , EUS , Helicobacter pylori除菌治療 , 化学療法 , 経過観察 pp.1397-1409
Published Date 1999/10/25
DOI https://doi.org/10.11477/mf.1403102844
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 The clinicopathological course was investigated in 22 patients with gastric MALT lymphoma who were followed up for more than one year after H. pylori eradication. Based on the findings by pretreatment endoscopic ultrasonography (EUS), cases were classified as either superficial, mass-forming, wall-thickening, or mixed types. During the follow-up after H. pylori eradication, complete remission (CR) was observed in 15 patients (68%), partial remission in one (5%), and no response (NR) in six (27%). Of the 15 cases in the CR group, 12 were classified as superficial type and three as mass-forming type before eradication. These 15 patients achieved CR 1~15 (mean, 4.7) months after eradication. No patients exhibited endoscopic relapse of lymphoma, while the histologic relapse was suspected in two cases, and reinfection of H. pylori was confirmed in another patient. Conversely, the NR group included three cases of wall-thickening type, two cases of mass-forming type, and one case of mixed type. Pretreatment EUS demonstrated the tumor invading the deep portion of the submucosa or beyond in all six cases. Oral monochemotherapy with a single alkylating agent was effective for two cases of the mass-forming type and one case of mixed type. When we compared several clinicopathologic factors prior to eradication between the CR and the NR groups, significant difference was observed only in H. pylori density and the EUS type. Neither the presence of high-grade component, nor perigastric lymphadenopathy, nor clinical stage was different between the two groups. We thus conclude that H. pylori eradication induces CR in most cases of superficial type gastric MALT lymphoma. For NR cases, other non-surgical treatments such as oral monochemotherapy or radiation should also be considered as one of the alternatives.

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