[3 unusual courses of gastrointestinal MALT lymphoma]. / 3 ungewöhnliche Verläufe von gastrointestinalen MALT-Lymphomen.

We report on the unusual course of disease in three patients with gastrointestinal MALT lymphoma. Special features are the primary lymphoma manifestation, the high-grade transformation during the follow up, the long-time interval between initially curative intended therapy and relapse and the occurrence of another neoplasia in one case. This demonstrates that despite their good prognosis in general, follow-up investigations of gastrointestinal MALT lymphoma are reasonable.

Patients with gastric MALT lymphoma revealing persisting endoscopic abnormalities after successful eradication of Helicobacter pylori can be safely managed by a watch-and-wait strategy.

BACKGROUND: In current guidelines, Helicobacter pylori eradication is recommended as first-line therapy in patients with gastric MALT lymphoma. This leads to complete lymphoma regression in the majority of patients. Those who show persisting histological residuals of lymphoma after eradication of the bacterium and normalization of endoscopic findings are managed by a watch-and-wait strategy. We aim to show that such an approach can be extended to patients with persisting endoscopic abnormalities. METHODS: Thirteen patients (7 female and 6 male; 62 years, range: 43 - 80) with gastric MALT lymphoma of stages I and II1 had received exclusive H. pylori eradication. Control endoscopies performed every 3 - 4 months during the first 2 years and 6 and 12 times monthly 2 - 5 and > 5 years after diagnosis, respectively, revealed successful eradication of H. pylori but persisting endoscopic abnormalities. Histologically, complete regression of the lymphoma or minor residuals were observed. RESULTS: Persisting endoscopic changes included thickened folds with or without superficial erosions, nodular mucosal surface with or without angiectasia, focal or diffuse atrophy, focal erythema, or a mixture of these findings. During a follow-up of 89.9 (12 - 329) months, the outcome of these patients was excellent with no single case of lymphoma progression. CONCLUSION: A watch-and-wait strategy can be recommended for patients with gastric MALT lymphoma showing persisting endoscopic abnormalities after eradication of H. pylori. There is no need for any oncological treatment provided that regular endoscopic-bioptic controls do not reveal any progressive changes. A standardized description of the endoscopic changes as well as a thorough bioptic technique should be included.