Turner Glenn, 1, Omar Jilani, MD2 1Baylor College of Medicine, Houston, TX; 2Baylor College of Medicine, The Woodlands, TX
Introduction: Extranodal Marginal Zone Lymphoma (ENMZL) of Gastric Mucosa Associated Lymphoid Tissue (MALT) is a low grade non-Hodgkin's lymphoma classically associated with chronic H. Pylori infection. Gastric MALT lymphoma presents a significant diagnostic challenge for the clinician due to nonspecific presenting symptoms and need for endoscopy with biopsy and histology. We present a case of gastric MALT lymphoma in a patient with longstanding nonspecific symptoms and endoscopic findings of patchy nonspecific gastritis.
Case Description/Methods: A 62-year-old female initially presented with mild constipation and abdominal bloating ongoing for the past 6 months. Abdominal x-ray showed minimal stool burden, and blood work including complete blood count, comprehensive metabolic panel, thyroid stimulating hormone and celiac disease panel was normal. Patient had a recent colonoscopy with adequate bowel prep and several tubular adenomas removed. The patient was started on Metamucil daily and Miralax with no improvement in her symptoms. She was subsequently recommended to undergo an upper endoscopy, which revealed moderate patchy mucosal changes with congestion, erythema, nodularity, and altered vascularity localized in the greater curvature of the gastric body. Biopsies revealed expansion of the lamina propria with atypical lymphoid infiltrate with CD20 and PAX5 positive B cells with aberrant co-expression of BCL-2 and CD43. Pathology was diagnostic for ENMZL of MALT. Repeat endoscopy confirmed the diagnosis, with no evidence of H. Pylori colonization. The patient was referred to radiation oncology for further management of the MALT lymphoma.
Discussion: Low grade lymphomas present with vague symptoms such as dyspepsia or decreased appetite. Additionally, the endoscopic appearance of low grade gastric lymphomas tends to be variable and even normal in some cases. The symptom of abdominal bloating led to the clinical decision to obtain an upper endoscopy. This case shows that during diagnostic uncertainty or vague presenting complaints further testing such as endoscopic evaluation may be warranted and should be pursued, if clinically indicated. Our case highlights the importance of a thorough clinical history and close examination of the upper gastrointestinal mucosa during endoscopy. It is imperative to report all findings thoroughly including the description and location of any mucosal abnormality with specimens obtained and placed in a separate bottle.
Figure: Endoscopic image of the greater curvature of the gastric body
Disclosures:
Turner Glenn indicated no relevant financial relationships.
Omar Jilani indicated no relevant financial relationships.
Turner Glenn, 1, Omar Jilani, MD2. P3394 - Rare Endoscopic Presentation of <i>H. Pylori</i> Negative Gastric MALT Lymphoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
