A 42-year-old woman presents with dyspepsia. Upper gastrointestinal endoscopy shows gastric erythema, and biopsy reveals a marginal zone B-cell lymphoma of MALT type. Testing for Helicobacter pylori is positive. There is no nodal involvement and no high-grade component. What is the recommended first-line management?
- A H. pylori eradication triple therapy followed by reassessment ✓
- B R-CHOP chemotherapy
- C Total gastrectomy
- D Involved-field radiotherapy to the stomach
Correct answer: A. H. pylori eradication triple therapy followed by reassessment
Explanation
Gastric MALT lymphoma is driven by chronic antigenic stimulation by H. pylori, and early-stage disease frequently regresses completely after bacterial eradication with standard triple therapy, making this the accepted first-line approach with repeat endoscopy and biopsy afterwards. R-CHOP is reserved for disseminated or transformed disease, and gastrectomy is obsolete as primary therapy. Radiotherapy is a second-line option for eradication failures, not initial treatment.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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