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Multicenter Study
. 2018 May 15;12(3):278-287.
doi: 10.5009/gnl17217.

Prevalence and Implications of Bone Marrow Involvement in Patients With Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

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Free PMC article
Multicenter Study

Prevalence and Implications of Bone Marrow Involvement in Patients With Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

Sang Il Choi et al. Gut Liver. .
Free PMC article

Abstract

Background/aims: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is an uncommon disease. Bone marrow involvement is reported even in patients with only a mucosal lesion. We evaluated the prevalence and risk factors of marrow involvement and its implications for diagnosis and treatment.

Methods: In total, 132 patients who were diagnosed with gastric MALT lymphoma at the National Cancer Center in Korea between January 2001 and December 2016 were enrolled in the study. The patient data were collected and analyzed retrospectively.

Results: Of the 132 patients, 47 (35.6%) were male, with a median age of 52 years (range, 17 to 81 years). The median follow-up duration was 48.8 months (range, 0.5 to 169.9 months). Helicobacter pylori infection was detected in 82 patients (62.1%). Most patients (80.3%) had stage IE1 according to the modified Ann Arbor staging system. Ninety-two patients underwent bone marrow evaluation, and four patients (4.3%) had marrow involvement. Of these patients, one presented with abdominal lymph node involvement, while the other three had stage IE1 disease if marrow involvement was disregarded. All three patients had no significant symptoms and were monitored after local treatment without evidence of disease aggravation.

Conclusions: Bone marrow involvement was found in 4.3% of the patients with gastric MALT lymphoma. Bone marrow examination may be deferred because marrow involvement does not change the treatment options or outcome in gastric MALT lymphoma confined to the stomach wall.

Keywords: Bone marrow involvement; Helicobacter pylori; Lymphoma, B-cell, marginal zone; Prognosis.

Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Study design. MALT, mucosa-associated lymphoid tissue; NCC, National Cancer Center; BM, bone marrow.
Fig. 2
Fig. 2
Endoscopic findings of four patients with bone marrow involvement. Lesions are indicated with black arrow. (A) Nodular elevation with central erosion at the lower body, anterior wall side in patient 1; (B) erythematous flat nodular mucosal change with surrounding whitish discoloration at fundus in patient 2; (C) slightly elevated erythematous change at proximal antrum, greater curvature/posterior wall side in patient 3; and (D) whitish flat discoloration with depression at the mid to lower body, lesser curvature side in patient 4.
Fig. 3
Fig. 3
Immunohistochemistry of CD 20 in bone marrow biopsy samples from three patients. Bone marrow biopsy from (A) left iliac bone of patient 1 (100×, 5% involvement); (B) right iliac bone of patient 2 (200×, 5% to 10% involvement); (C) left iliac bone of patient 3 (200×, 5% involvement); and (D) left iliac bone of patient 3 at 6 months after the Helicobacter pylori eradication therapy showing no evidence of involvement (200×).

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