Nonaka K, Ishikawa K, Arai S, Nakao M, Shimizu M, Sakurai T, Nagata K, Nishimura M, Togawa O, Ochiai Y, Sasaki Y, Kita H. A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis. World J Gastrointest Endosc 2012; 4(4): 151-156 [PMID: 22523617 DOI: 10.4253/wjge.v4.i4.151]
Corresponding Author of This Article
Hiroto Kita, MD, Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidakashi, Saitama 350-1298, Japan. hkita@saitama-med.ac.jp
Article-Type of This Article
Case Report
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Kouichi Nonaka, Keiko Ishikawa, Shin Arai, Masamitsu Nakao, Makoto Nishimura, Osamu Togawa, Yasutoshi Ochiai, Hiroto Kita, Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
Michio Shimizu, Takaki Sakurai, Koji Nagata, Department of Pathology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan
Yutaka Sasaki, Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences Kumamoto University, Kumamoto 860-8556, Japan
Author contributions: Nonaka K conceived and designed the study, generated and analyzed data, drafted and revised the manuscript; Shimizu M, Sakurai T and Nagata K performed pathological analysis and interpreted the data; Ishikawa K and Arai S conceived and designed the study, analyzed and interpreted the data; Nakao M, Nishimura M, Togawa O and Ochiai Y made supportive contributions; Sasaki Y and Kita H conceived and designed the study and approved the final version of the manuscript.
Correspondence to: Hiroto Kita, MD, Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidakashi, Saitama 350-1298, Japan. hkita@saitama-med.ac.jp
Telephone: +81-4-29840053 Fax: +81-4-29840054
Received: August 30, 2011 Revised: November 14, 2011 Accepted: March 1, 2012 Published online: April 16, 2012
Abstract
Recently, we reported a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestone-like mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.
