A 45-year-old man with dyspepsia undergoes endoscopy showing a superficial gastric ulcer in the body. Histology reveals a low-grade B-cell lymphoma of marginal zone type positive for H. pylori infection. Staging shows disease confined to the gastric wall. What is the first-line management?

• A Total gastrectomy
• B CHOP chemotherapy
• C Rituximab monotherapy immediately
• D H. pylori eradication therapy with repeat endoscopy at 3 months ✓

Explanation

Low-grade gastric MALT lymphoma is driven by H. pylori antigenic stimulation, and eradication therapy alone achieves complete regression in up to 80 percent of H. pylori-positive cases limited to the mucosa or submucosa. Response is assessed endoscopically and histologically after about three months. Surgery and systemic chemotherapy are reserved for eradication failures or advanced-stage disease. Rituximab is a second-line option, not first-line.

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.