Endoscopy and biopsy in a 45-year-old man reveal a low-grade gastric B-cell lymphoma of marginal zone type confined to the mucosa. H. pylori is detected on histology. There is no deeper invasion and no nodal disease. What is the correct first step in management?
- A Total gastrectomy with D2 lymphadenectomy
- B H. pylori eradication therapy followed by repeat endoscopy at 3 months ✓
- C CHOP chemotherapy followed by involved-field radiotherapy
- D Rituximab monotherapy as initial treatment
Correct answer: B. H. pylori eradication therapy followed by repeat endoscopy at 3 months
Explanation
Early stage gastric MALT lymphoma is driven by H. pylori antigenic stimulation, and eradication therapy alone achieves complete regression in the majority of cases limited to the mucosa or submucosa without nodal spread. Response is assessed endoscopically and histologically after about three months. Gastrectomy, chemotherapy and radiotherapy are reserved for eradication failures, t(11;18) positive tumours or advanced disease.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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