Endoscopic biopsies from a 45-year-old man with dyspepsia show a low-grade gastric B-cell lymphoma of marginal zone type (MALT lymphoma). H. pylori organisms are demonstrated on histology. There is no deep invasion, no high-grade component, and no nodal involvement. What is the appropriate first step in management?

• A Total gastrectomy with D2 lymphadenectomy
• B CHOP chemotherapy followed by involved-field radiotherapy
• C Rituximab monotherapy as initial treatment
• D H. pylori eradication therapy with repeat endoscopy and biopsies at 3 to 6 months ✓

Explanation

Early-stage, H. pylori-positive low-grade gastric MALT lymphoma regresses completely in a majority of patients after eradication therapy alone, which is the standard first-line treatment. Repeat endoscopy with biopsies at 3 to 6 months assesses response. Gastrectomy was historical practice and is now reserved for failures. Radiotherapy or rituximab-containing regimens are second-line options for eradication-refractory or H. pylori-negative disease, not initial therapy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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