Unusual presentation of MALT lymphoma. A case report

Abstract

Introduction. MALT lymphoma is the most common type of extranodal non-Hodgkin lymphoma. In two-thirds of cases, it originates in the stomach and is strongly associated with Helicobacter pylori infection. It presents a complex clinical picture, that can resemble multiple conditions, and typically follows a benign course. Clinical case presentation. This report discusses an uncommon case of a 52-year-old female who presented to the oncologist with insignificant weight loss, episodes of melena and fatigue. The disease started in 2018 with upper gastrointestinal bleeding from a gastric ulcer caused by H. pylori, which was later eradicated. The patient underwent multiple upper endoscopies over the years, with no evidence of malignancy. During the most recent investigation, an ulcerated mass of about 20 mm with infiltration of the adjacent mucosa was found. The biochemical and serological examination was within normal values. Abdominal computed tomography revealed unexplained perigastric and intestinal lymphadenopathy. The patient underwent total gastrectomy and lymph node dissection due to suspected gastric cancer. Histological and immunohistochemical examinations confirmed advanced MALT lymphoma with tumour cells positive for cluster of differentiation 45, 20 (CD45, CD20) and B-cell lymphoma 2 (BCL2). Given the advanced stage of the disease, adjuvant polychemotherapy was also administered, and the patient’s condition improved significantly. Conclusions. MALT lymphoma is a rare condition that requires close attention and a high index of suspicion, even in unusual cases like the one presented. Endoscopic examination performed by an experienced specialist, accompanied by proper biopsy and a multidisciplinary team approach increases the survival rate of patients.