Medical College of Georgia at Augusta University Augusta, GA
Angela Barnes, MD, MBChB1, Kwabena O. Adu-Gyamfi, MD2, Kwabena Asafo-Agyei, MBChB2, Amanda Barrett, MD3, John Erikson Yap, MD, MBA, FACG4, Humberto Sifuentes, MD3 1Medical College of Georgia at Augusta University, Augusta, GA; 2Medical College of Georgia, Augusta University, Augusta, GA; 3Augusta University, Augusta, GA; 4Metrodora Institute, West Valley City, UT
Introduction: Mucosa-associated lymphoid tissue (MALT) lymphoma is an infrequent subtype of non-Hodgkin lymphoma characterized by its indolent growth pattern. It typically arises within mucosal sites, with the stomach and small intestines being the most prevalent locations. Colonic MALT lymphoma, accounting for a mere 2.5%, is exceptionally rare. Herein, we present a unique case of synchronous occurrence of MALT lymphoma involving both the gastric and colonic mucosa.
Case Description/Methods: A 52-year-old male with a history of peptic ulcer disease was referred for endoscopic evaluation due to persistent dyspepsia unresponsive to proton pump inhibitor (PPI) therapy, and screening colonoscopy. Examination revealed normal vital signs and physical examination. Esophagogastroduodenoscopy (EGD) revealed scattered gastric erosions and colonoscopy identified a 12mm distal transverse colon polypoid lesion with a depressed center (NICE 3, PARIS IS+IIA), both were biopsied. Histopathology revealed extranodal marginal zone lymphoma consistent with MALT lymphoma in both the gastric and colonic tissues. Helicobacter pylori infection was ruled out. Immunohistochemical staining demonstrated a predominance of CD20 positive B-cells. Fluorescence in situ hybridization (FISH) studies confirmed the presence of t(11;18) translocation in both samples.
Subsequent chest computed tomography (CT) revealed mediastinal adenopathy and extensive pulmonary cysts. Considering the distribution, morphology, and pathology results, amyloid associated cystic lung disease associated with MALT lymphoma was considered. Abdominal/pelvic CT demonstrated multiple enlarged lymph nodes adjacent to the gastric antrum, splenic flexure, and proximal transverse colon. The patient was jointly managed by the Pulmonary and Oncology Teams, receiving treatment comprising PPI therapy and Rituximab. He remains clinically stable with no symptoms suggestive of active lymphoma.
Discussion: Gastric MALT lymphoma commonly presents with nonspecific symptoms such as dyspepsia, whereas colonic involvement may manifest as colonic mass, gastrointestinal bleeding, abdominal pain, perforation, intestinal obstruction, or may remain asymptomatic. Due to its rarity, colonic MALT lymphoma has been inadequately studied and lacks clear management guidelines. However, surgical resection and chemotherapy, particularly Rituximab, have emerged as mainstays of treatment, often yielding favorable responses in clinical practice.
Figure: A) Scattered gastric erosions B) Gastric biopsy: 400X H&E shows infiltration and destruction of glands (infiltrated gland is circled) by small lymphocytes (few indicated by arrows), termed a lymphoepithelial lesion. C) Gastric biopsy: 40x CD20 immunohistochemical stain shows most lymphocytes are positive for CD20, a B-cell marker. D) Transverse colon polypoid lesion with a depressed center E) Colon Biopsy: 400x H&E demonstrating a lymphoepithelial lesion (circled, arrows on lymphocytes) F) Colon Biopsy: 40x CD20 immunostain again shows that most of the lymphocytes are positive for this B-cell marker
Disclosures:
Angela Barnes indicated no relevant financial relationships.
Kwabena Adu-Gyamfi indicated no relevant financial relationships.
Kwabena Asafo-Agyei indicated no relevant financial relationships.
Amanda Barrett indicated no relevant financial relationships.
John Erikson Yap indicated no relevant financial relationships.
Humberto Sifuentes indicated no relevant financial relationships.
Angela Barnes, MD, MBChB1, Kwabena O. Adu-Gyamfi, MD2, Kwabena Asafo-Agyei, MBChB2, Amanda Barrett, MD3, John Erikson Yap, MD, MBA, FACG4, Humberto Sifuentes, MD3. P0333 - Synchronous Gastric and Colonic MALT Lymphoma: A Rare Occurrence, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
