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Successful Treatment of a Patient With Gastric Mucosa-Associated Lymphoma
Accepted Manuscript Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma Jiten P. Kothadia, MD, Vyshnavi Kone, MD, Abbas Raza, MD
PII: DOI: Reference:
S1542-3565(17)31067-4 10.1016/j.cgh.2017.09.006 YJCGH 55438
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 3 September 2017 Please cite this article as: Kothadia JP, Kone V, Raza A, Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.09.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
1
Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma
Jiten P. Kothadia, MD1; Vyshnavi Kone, MD 1; Abbas Raza, MD1
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1. Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, 3300 NW Expressway,
Jiten P. Kothadia, MD Transplant Hepatologist
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Oklahoma City, OK 73112
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Nazih Zuhdi Transplant Institute
INTEGRIS Baptist Medical Center
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3300 NW Expressway, Oklahoma City, OK 73112 Phone: 609-865-6418 Fax: 405-951-9860 Email: [email protected]
Short Title: Gastric MALT lymphoma
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Key words:
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Gastric ulcer, abdominal pain, MALT lymphoma, helicobacter pylori, cancer
Author Contributions:
Jiten P. Kothadia, MD: Concept and design, acquisition of available literature, and drafting of the
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article
Vyshnavi Karna, MD: Literature review and drafting of the article.
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Abbas Raza, MD: Critical revision of the manuscript for important intellectual content.
Authors’ disclosures of potential conflicts of interest:
Financial disclosure:
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None to report.
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The author(s) indicated no potential conflicts of interest.
Case Discussion:
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A 59-year-old female with a history of intermittent epigastric pain for four months underwent esophagogastroduodenoscopy (EGD) that revealed a large 2 cm gastric ulcer (Figure A). She was negative for Helicobacter pylori (H. pylori). Excisional biopsies of ulcer showed atypical
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lymphoid cells and lymphoepithelial lesions (Figure B) with positive PAX-5 immunostaining consistent with a primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma (Figure C).
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Her metastatic work up was negative with normal bone marrow biopsy. She was treated with triple antibiotic therapy for 14 days. Repeat EGD showed completely healed ulcer (Figure
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D) but repeat biopsy still showed presence of MALT lymphoma. She was treated with bendamustine and rituximab for 4 cycles. Repeat EGD after treatment showed complete resolution of lymphoma.
MALT-Lymphomas are the extranodal marginal zone lymphomas with stomach being
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most commonly involved organ and 90 % case are infected with H. Pylori. Though the pathogenesis is still unclear in H. pylori-negative MALT lymphomas. Suggested etiology include genetic alterations; most commonly t (11; 18) (q21; q21), involvement of other bacteria or
EP
presence of autoimmune disease. Every patient irrespective of H. pylori status the first-line treatment for MALT lymphoma is antibiotic therapy as studies show higher remission rate with
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this therapy.
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PII: DOI: Reference:
S1542-3565(17)31067-4 10.1016/j.cgh.2017.09.006 YJCGH 55438
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 3 September 2017 Please cite this article as: Kothadia JP, Kone V, Raza A, Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/ j.cgh.2017.09.006. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
1
Successful Treatment of a Patient With Gastric Mucosa-associated Lymphoma
Jiten P. Kothadia, MD1; Vyshnavi Kone, MD 1; Abbas Raza, MD1
RI PT
1. Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, 3300 NW Expressway,
Jiten P. Kothadia, MD Transplant Hepatologist
TE D
M AN U
SC
Oklahoma City, OK 73112
EP
Nazih Zuhdi Transplant Institute
INTEGRIS Baptist Medical Center
AC C
3300 NW Expressway, Oklahoma City, OK 73112 Phone: 609-865-6418 Fax: 405-951-9860 Email: [email protected]
Short Title: Gastric MALT lymphoma
ACCEPTED MANUSCRIPT
2
Key words:
RI PT
Gastric ulcer, abdominal pain, MALT lymphoma, helicobacter pylori, cancer
Author Contributions:
Jiten P. Kothadia, MD: Concept and design, acquisition of available literature, and drafting of the
SC
article
Vyshnavi Karna, MD: Literature review and drafting of the article.
M AN U
Abbas Raza, MD: Critical revision of the manuscript for important intellectual content.
Authors’ disclosures of potential conflicts of interest:
Financial disclosure:
AC C
EP
None to report.
TE D
The author(s) indicated no potential conflicts of interest.
Case Discussion:
ACCEPTED MANUSCRIPT
3
A 59-year-old female with a history of intermittent epigastric pain for four months underwent esophagogastroduodenoscopy (EGD) that revealed a large 2 cm gastric ulcer (Figure A). She was negative for Helicobacter pylori (H. pylori). Excisional biopsies of ulcer showed atypical
RI PT
lymphoid cells and lymphoepithelial lesions (Figure B) with positive PAX-5 immunostaining consistent with a primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma (Figure C).
SC
Her metastatic work up was negative with normal bone marrow biopsy. She was treated with triple antibiotic therapy for 14 days. Repeat EGD showed completely healed ulcer (Figure
M AN U
D) but repeat biopsy still showed presence of MALT lymphoma. She was treated with bendamustine and rituximab for 4 cycles. Repeat EGD after treatment showed complete resolution of lymphoma.
MALT-Lymphomas are the extranodal marginal zone lymphomas with stomach being
TE D
most commonly involved organ and 90 % case are infected with H. Pylori. Though the pathogenesis is still unclear in H. pylori-negative MALT lymphomas. Suggested etiology include genetic alterations; most commonly t (11; 18) (q21; q21), involvement of other bacteria or
EP
presence of autoimmune disease. Every patient irrespective of H. pylori status the first-line treatment for MALT lymphoma is antibiotic therapy as studies show higher remission rate with
AC C
this therapy.
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