Primary non-Hodgkin lymphoma of the gastric stump

Patients with a history of gastroduodenal surgery for benign lesions are at increased risk of developing cancer of the gastric stump. The majority of malignant tumors arising in gastric remnants are adenocarcinomas, but a few of cases of malignant lymphoma have been reported as well. Some recent studies have suggested that Helicobacter pylori-associated gastritis may play a role in the pathogenesis of primary gastric lymphoma. We report a case of primary high grade polymorphic B-cell lymphoma (high grade MALT lymphoma) occurring in the gastric stump of a 74-year-old man 17 years after Billroth-II gastrectomy. The non-tumorous gastric mucosa showed features of reflux gastritis with presence of deeply situated dense lymphoid aggregates in the lamina propria. However, no micro-organisms with the morphology of Helicobacter pylori could be found at the luminal surface. The literature concerning gastric stump lymphomas is reviewed.