Helicobacter pylori感染を伴った胃MALT lymphomaの1例

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  • A CASE REPORT OF GASTRIC MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA WITH HELICOBACTER PLYORI INFECTION

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A 53-year-old woman was seen at the hospital because of epigastralgia and was pointed out have multiple ulcer like lesions of the stomach on upper gastrointestinal series. Mucosa-associated lymphoid tissue (MALT) lymphoma was diagnosed by endoscopically obtained biopsy specimen. High serum antiboty titer for Helicobacter pylori (H. pylori) was noted. H. pylori was identified on the biopsy specimen using by polymerase chain reaction. Although H. pylori was completely eradicated by amoxicillin-metronidazole-bismuth subnitrate triple therapy and lansoprazole, MALT lymphoma did not disappeared. Thus, a total gastrectomy with lymph node dissection was indicated. The histological sections showed multifocal small lesions of lymphoma cells and medium-sized follicle centrocyte-like cell infiltration in the mucosa and submucosa. The intramucosal lesions showed lymphoepithelial lesions. These findings were indicative of MALT lymphoma. She had been doing without any signs of recurrence as of 13 months after the operation.<br> Recently the relation between MALT lymphoma of the stomach and H. pylori has been indicated, and the disappearance of gastric MALT lymphoma due to eradication of H. pylori has been increasingly reported. We propose the guidelines for the treatment of MALT lymphoma that H. pylori is eradicated first and thereafter an operation is performed if it is ineffective. On the other hand, we should continue to conduct gastric endoscopy even after H. pylori disappear, and perform an operation if sign of recurrence is noted.

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