Endoscopic ultrasound in the evaluation of gastric small lymphocytic mucosa-associated lymphoid tumors Journal Article

Authors: Pavlick, A. C.; Gerdes, H.; Portlock, C. S.
Article Title: Endoscopic ultrasound in the evaluation of gastric small lymphocytic mucosa-associated lymphoid tumors
Abstract: Purpose: Low-grade, small lymphocytic lymphomas of the mucosa-associated lymphoid tissue (MALT) have recently been shown to be associated with Helicobacter pylori infections. Regression of these tumors has been reported with antibiotic therapy. Here we evaluate endoscopic ultrasound (EUS) as an objective method to evaluate pretreatment disease and posttherapy response. Materials and Methods: We retrospectively reviewed 20 patients initially diagnosed elsewhere with MALT lymphoma. All patients had their initial endoscopic biopsies (EGDs) reviewed at Memorial Sloan-Kettering Cancer Center (MSKCC). All patients had EUS performed at the time of consultation and on completion of therapy if treated at our center. Antral biopsies were stained with a modified Steiner preparation to determine infection by H pylori. Results: Gastric low-grade lymphoma was confirmed in 16 of 20 patients; 11 of 16 had previously received antibiotic therapy for biopsy-positive H pylori infection. All gastric lymphomas had an abnormal EUS: eight with discrete tumor masses and eight with gastric wall infiltration (submucosa, n = 4; muscularis propria, n = 3; serosa, n = 1). On completion of lymphoma treatment with chemotherapy, radiotherapy, or surgery, 11 of 16 patients underwent follow-up EUS. Five patients received care elsewhere and did not return for posttreatment EUS. The gastric wall was normal with no evidence of disease on EUS-guided biopsy in eight of 11 patients. The remaining three patients had abnormal gastric walls. One was biopsy-negative and two had residual lymphoma. Four patients were found to have benign lymphoid aggregates in association with H pylori on initial EGD and EUS biopsies. All four patients were previously untreated with antibiotics. EUS showed prominent mucosa, but no significant findings within the gastric wall. Conclusion: EUS appears useful to stage objectively and evaluate therapeutic outcome in the management of gastric, low-grade MALT lymphomas. It also helps to distinguish benign lymphoid aggregates from lymphoma associated with H pylori infection. EUS findings may have a significant impact an assessment and therapeutic recommendations.
Keywords: adult; clinical article; human tissue; aged; middle aged; cancer grading; adenocarcinoma; diagnosis, differential; biopsy; anti-bacterial agents; stomach neoplasms; helicobacter infections; helicobacter pylori; endoscopic echography; mucosa associated lymphoid tissue lymphoma; gram negative infection; stomach lymphoma; lymphoma, mucosa-associated lymphoid tissue; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 15
Issue: 5
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1997-05-01
Start Page: 1761
End Page: 1766
Language: English
PUBMED: 9164183
PROVIDER: scopus
DOI: 10.1200/JCO.1997.15.5.1761
Notes: Article -- Export Date: 17 March 2017 -- Source: Scopus
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MSK Authors
  1. Hans Gerdes
    126 Gerdes
  2. Carol Portlock
    179 Portlock