A 52-year-old man undergoes endoscopy for dyspepsia. Biopsy of a pale area in the gastric body shows B-cell lymphoma of marginal zone type (MALT lymphoma). Testing for Helicobacter pylori is positive and there is no evidence of high-grade transformation or deep invasion on staging endoscopic ultrasound. What is the correct first-line management?
- A H. pylori eradication therapy followed by repeat endoscopy and biopsy at 3 months ✓
- B Total gastrectomy with D2 lymphadenectomy
- C Immediate CHOP chemotherapy with rituximab
- D Radiotherapy to the gastric fundus alone
Correct answer: A. H. pylori eradication therapy followed by repeat endoscopy and biopsy at 3 months
Explanation
Low-grade gastric MALT lymphoma is driven by H. pylori antigenic stimulation, and eradication therapy achieves complete regression in the majority of early-stage cases. Response is assessed with repeat endoscopy and biopsies several months later. Gastrectomy is obsolete as first-line therapy, and chemotherapy or radiotherapy is reserved for eradication failures or H. pylori-negative disease, so they are not initial treatment.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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