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World J Gastrointest Oncol. Apr 15, 2010; 2(4): 181-186
Published online Apr 15, 2010. doi: 10.4251/wjgo.v2.i4.181
Gastric low-grade mucosal-associated lymphoid tissue-lymphoma: Helicobacter pylori and beyond
Angelo Zullo, Cesare Hassan, Francesca Cristofari, Francesco Perri, Sergio Morini
Angelo Zullo, Cesare Hassan, Francesca Cristofari, Sergio Morini, Gastroenterology and Digestive Endoscopy, “Nuovo Regina Margherita” Hospital, 00153 Roma, Italy
Francesco Perri, Gastroenterology and Digestive Endoscopy, “Casa Sollievo della Sofferenza” Hospital, IRCCS, 71013 San Giovanni Rotondo (FG), Italy
Author contributions: Authors equally contributed to this paper.
Correspondence to: Dr. Angelo Zullo, Gastroenterologia ed Endoscopia Digestiva, PTP Nuovo Regina Margherita, Via E. Morosini, 30, 00153 Roma, Italy.
Telephone: +39-6-58446608 Fax: +39-6-58446533
Received: August 12, 2009
Revised: October 18, 2009
Accepted: October 25, 2009
Published online: April 15, 2010

The stomach is the most frequently involved site for extranodal lymphomas, accounting for nearly two-thirds of all gastrointestinal cases. It is widely accepted that gastric B-cell, low-grade mucosal-associated lymphoid tissue (MALT)-lymphoma is caused by Helicobacter pylori (H. pylori) infection. MALT-lymphomas may engender different clinical and endoscopic patterns. Often, diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa. H. pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage (I-II1). Neoplasia confined to the submucosa, localized in the antral region of the stomach, and without API2-MALT1 translocation, shows a high probability of remission following H. pylori eradication. When both bacterial infection and lymphoma recur, further eradication therapy is generally effective. Radiotherapy, chemotherapy and, in selected cases, surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission, while data on immunotherapy with monoclonal antibodies (rituximab) are still scarce. The 5-year survival rate is higher than 90%, but careful, long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.

Keywords: Mucosal-associated lymphoid tissue, Therapy, Helicobacter pylori, Gastric lymphoma, Predictive factors, Endoscopy, Clinical presentation