A 52-year-old woman undergoes endoscopy for epigastric discomfort. Multiple biopsies show sheets of marginal zone B cells infiltrating the lamina propria with lymphoepithelial lesions, consistent with low-grade gastric MALT lymphoma. Rapid urease test is positive. What is the most appropriate first step in management?
- A Total gastrectomy with regional lymphadenectomy
- B Helicobacter pylori eradication therapy followed by reassessment of the gastric response ✓
- C Immediate combination chemotherapy with rituximab-based regimen
- D External beam radiotherapy to the gastric fundus
Correct answer: B. Helicobacter pylori eradication therapy followed by reassessment of the gastric response
Explanation
Low-grade gastric MALT lymphoma is driven by antigenic stimulation from Helicobacter pylori, and eradication therapy leads to complete histological regression in a large majority of H pylori-positive cases. Response should be assessed endoscopically and histologically over months before considering radiotherapy, chemotherapy or surgery, which are reserved for persistent or transformed disease. Gastrectomy is now rarely used as primary treatment for low-grade disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.