Endoscopy and biopsy in a 58-year-old man reveal a low-grade B-cell marginal zone (MALT) lymphoma of the stomach, Helicobacter pylori positive, with no nodal or distant disease on staging. What is the correct first-line management?
- A Total gastrectomy with D2 lymphadenectomy
- B Immediate radiotherapy to the gastric bed
- C H. pylori eradication therapy followed by reassessment in 3 to 6 months ✓
- D CHOP chemotherapy combined with rituximab
Correct answer: C. H. pylori eradication therapy followed by reassessment in 3 to 6 months
Explanation
Low-grade gastric MALT lymphoma is driven by H. pylori antigenic stimulation, and eradication therapy achieves complete histological regression in the majority of stage IE cases. Response is assessed after several months because regression is slow. Gastrectomy is obsolete as primary treatment here, and chemotherapy or radiotherapy are reserved for eradication failures, higher-grade transformation, or t(11;18)-positive tumours resistant to antibiotics.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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