Journal of the Formosan Medical Association
Volume 109, Issue 6 , Pages 463-471, June 2010

Early Low-grade Gastric MALToma Rarely Transforms Into Diffuse Large Cell Lymphoma or Progresses Beyond the Stomach and Regional Lymph Nodes

  • Ting-Yun Liu

      Affiliations

    • Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Pei-Han Dei

      Affiliations

    • Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Sung-Hsin Kuo

      Affiliations

    • Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • ,
  • Chung-Wu Lin

      Affiliations

    • Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Chung-Wu Lin, Department of Pathology, National Taiwan University College of Medicine, Jen-Ai Road, Taipei, 10016 Taiwan

Received 20 May 2009; received in revised form 9 August 2009; accepted 26 August 2009.

Article Outline

Background/Purpose

Gastric mucosa-associated lymphoid tissue lymphoma (MALToma) usually presents at an early stage involving only the stomach and/or regional lymph nodes. Although a sequential transformation from low-grade gastric MALToma (GM) to high-grade GM to secondary diffuse large B-cell lymphoma (DLBCL) is commonly assumed, documented cases of transformation are rare. We aim to determine the frequency of transformation.

Methods

We identified 55 early low-grade GMs, 18 early high-grade GMs, and 13 advanced GMs at the National Taiwan University Hospital from 1995 to 2005. The median follow-up time was 59 months.

Results

We found that only one early low-grade GM and two early high-grade GMs transformed into secondary DLBCLs and progressed outside the stomach and regional lymph nodes. Significantly, we identified 13 low-grade GMs that were refractory to Helicobacter eradication therapy or relapsed after initial response. All 13 cases had been followed-up for at least 3 years without development of secondary DLBCLs. The frequency of transformation for early low-grade GM was less than 2% (1/55). Although two lymphoma-unrelated mortalities were identified, none of the 55 patients with early-low grade GMs died of the disease.

Conclusion

Compared with chronic lymphocytic leukemia, which has a 16% transformation rate and a median transformation time of 24 months, we conclude that early low-grade GM rarely transforms into secondary DLBCL or progresses beyond the stomach. Without transformation or progression, patients with early low-grade GM rarely die of the disease and should be treated conservatively.

Key Words:  gastric mucosa-associated lymphoid tissue lymphoma , progression , transformation

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PII: S0929-6646(10)60078-2

doi:10.1016/S0929-6646(10)60078-2

Journal of the Formosan Medical Association
Volume 109, Issue 6 , Pages 463-471, June 2010

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