A 40-year-old man with dyspepsia has endoscopy showing a superficial gastric ulcer. Biopsy reveals a low-grade B-cell lymphoma of marginal zone type (MALT lymphoma). Testing for Helicobacter pylori is positive. FISH analysis demonstrates the t(11;18)(q21;q21) translocation. Which statement guides his management?
- A H. pylori eradication is first-line therapy, but the presence of t(11;18) predicts a lower chance of regression and closer monitoring or earlier radiotherapy or chemotherapy may be needed ✓
- B Total gastrectomy with D2 lymphadenectomy is the treatment of choice regardless of stage
- C The t(11;18) translocation confirms transformation to diffuse large B-cell lymphoma requiring R-CHOP
- D Eradication therapy is contraindicated because it accelerates lymphoma progression
Correct answer: A. H. pylori eradication is first-line therapy, but the presence of t(11;18) predicts a lower chance of regression and closer monitoring or earlier radiotherapy or chemotherapy may be needed
Explanation
Low-grade gastric MALT lymphoma is driven by H. pylori antigenic stimulation, and eradication therapy achieves complete regression in a majority of early-stage cases, making it first-line treatment. However, the t(11;18) translocation, which creates an API2-MALT1 fusion gene, is associated with resistance to eradication therapy, so such patients need close endoscopic follow-up and often second-line treatment such as radiotherapy. Total gastrectomy is obsolete for this disease, and t(11;18) is characteristic of MALT lymphoma itself, not transformation to DLBCL.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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