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MALT lymphoma

Last updated: July 20, 2020

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Mucosa-Associated Lymphoid Tissue (MALT) lymphoma (also called MALToma or extranodal marginal zone lymphoma) is a B-cell non-Hodgkin lymphoma (NHL) that typically affects elderly patients in the 7th and 8th decades. MALTomas can be categorized according to their location as either gastric or nongastric. Gastric MALTomas are frequently associated with Helicobacter pylori (H. pylori) infection, whereas nongastric MALTomas are rather associated with autoimmune conditions (e.g., Sjögren syndrome, Hashimoto's thyroiditis). MALTomas typically present with nonspecific symptoms (e.g., fatigue, weight loss) and an unremarkable physical exam. Diagnosis is based on histopathology and immunohistochemistry. In the case of gastric MALTomas, a biopsy should be performed by upper gastrointestinal (UGI) endoscopy. Imaging techniques such as computed tomography (CT) are used for staging purposes. Treatment depends on the type of MALToma: Gastric MALTomas, for example, are treated in most cases with the eradication of the underlying H. pylori infection, whereas nongastric MALTomas are treated with radiation, chemotherapy, and surgery.

  • Approx. 5% of NHLs are due to MALTomas
  • Peak incidence: 7th and 8th decades

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

MALTomas show an association with chronic immune stimulation (bacterial, autoimmune)! References:[1][2][3]

References:[1][4]

General approach

Gastric MALToma

References:[1][5]

Gastric MALTomas

Nongastric MALToma

  • Depends on the exact type and staging
  • Treatment options include : radiation, chemotherapy, surgery for local diseases

References:[1][5]

  1. Common Misconceptions in the Management of Helicobacter pylori-associated Gastric MALT-lymphoma. Gisbert JP, Calvet X. Gisbert JP, Calvet X. New York, NY: WebMD. http://www.medscape.com/viewarticle/751900_1. Updated: January 1, 2011. Accessed: December 27, 2016.
  2. Crowe SE. Association between Helicobacter pylori infection and gastrointestinal malignancy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/association-between-helicobacter-pylori-infection-and-gastrointestinal-malignancy.Last updated: May 3, 2016. Accessed: December 27, 2016.
  3. Grethlein SJ. Mucosa-Associated Lymphoid Tissue. In: Besa EC, Mucosa-Associated Lymphoid Tissue. New York, NY: WebMD. http://emedicine.medscape.com/article/207891. Updated: December 9, 2014. Accessed: December 27, 2016.
  4. Le T, Bhushan V, Sochat M, Petersen M, Micevic G, Kallianos K. First Aid for the USMLE Step 1 2014. McGraw-Hill Medical ; 2014
  5. Freedman AS. Management of gastrointestinal lymphomas. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-gastrointestinal-lymphomas.Last updated: January 15, 2016. Accessed: December 27, 2016.
  6. Herold G. Internal Medicine. Herold G ; 2014