Primary gastric MALT lymphoma: trivial condition or serious disease?

Primary gastric B-cell lymphomas originating from the mucosa-associated lymphoid tissue (MALT) have been demonstrated to be closely associated with Helicobacter pylori infection. Approximately 70% of these tumors regress within 1 year of eradication of H. pylori. Currently, there is little consensus on the best strategies for diagnosing, treating, and following up these lymphomas. Our objective was to review the current strategies for the diagnosis and management of MALT lymphomas and to describe the management guidelines used in our own institution.

Our approach consisted of a review of the literature and personal experience.

Rigorous histopathological criteria (Isaacson's criteria) must be applied to the diagnosis of gastric biopsies with atypical lymphoid aggregates. Molecular and immunohistochemical studies might play have a role in determining the clonality of the lesions, but correlation with the histopathological aspects is crucial.

Little solid information exists on the natural history and evolution of MALT lymphomas. While studies are being carried out, we suggest that even a suspected MALT lymphoma in a gastric biopsy specimen should be treated as a potentially serious condition. The diagnosis should be confirmed by an experienced histopathological laboratory, and H. pylori infection must be sought and treated. Because the response of lymphomas to antibacterial therapy cannot be predicted, close follow-up of affected patients is essential.