Regular Article

British Journal of Cancer (2000) 83, 454–457. doi:10.1054/bjoc.2000.1308 www.bjcancer.com
Published online 25 July 2000

Importance of extensive staging in patients with mucosa-associated lymphoid tissue (MALT)-type lymphoma

M Raderer1, F Vorbeck2, M Formanek3, C Österreicher4, J Valencak5, M Penz1, G Kornek1, G Hamilton6, B Dragosics4 and A Chott5

  1. 1Department of Internal Medicine I, Division of Oncology, University of Vienna, Waehringer Guertel 18–20 A-1090 Vienna, Austria
  2. 2Department of Internal Medicine I, Division of Radiology, University of Vienna, Waehringer Guertel 18–20 A-1090 Vienna, Austria
  3. 3Department of Internal Medicine I, Division of Otolaryngology, University of Vienna, Waehringer Guertel 18–20 A-1090 Vienna, Austria
  4. 4Division of Internal Medicine IV, University of Vienna, Waehringer Guertel 18–20 A-1090 Vienna, Austria
  5. 5Department of Internal Medicine I, Division of Clinical Pathology, University of Vienna, Waehringer Guertel 18–20 A-1090 Vienna, Austria
  6. 6Ludwig Boltzmann Institute for Clinical Oncology, KH Lainz, Vienna, Austria

Received 19 October 1999; Revised 2 March 2000; Accepted 13 April 2000.

Top

Abstract

Lymphoma of the mucosa-associated lymphoid tissue (MALT) type usually arises in MALT acquired through chronic antigenic stimulation triggered by persistent infection and/or autoimmune processes. Due to specific ligand–receptor interactions between lymphoid cells and high-endothelial venules of MALT, both normal and neoplastic lymphoid cells display a pronounced homing tendency to MALT throughout the body. In the case of neoplastic disease these homing properties may be responsible for lymphoma dissemination among various MALT-sites. According to this concept, we have standardized staging procedures in all patients diagnosed with MALT-type lymphoma. All patients with MALT-type lymphoma underwent standardized staging procedures before treatment. Staging included ophthalmologic examination, otolaryngologic investigation, gastroscopy with multiple biopsies, endosonography of the upper gastrointestinal tract, enteroclysis, colonoscopy, computed tomography of thorax and abdomen and bone marrow biopsy. Biopsy was performed in all lesions suggestive for lymphomatous involvement, and evaluation of all biopsy specimens was performed by a reference pathologist. 35 consecutive patients with histologically verified MALT-type lymphoma were admitted to our department. Twenty-four patients (68%) had primary involvement of the stomach, five (15%) had lymphoma of the ocular adnexa, three (8.5%) had lymphoma of the parotid, and three (8,5%) of the lung. Lymph-node involvement corresponding to stage EII disease was found in 13 patients (37%), only one patient with primary gastric lymphoma had local and supradiaphragmatic lymph-node involvement (stage EIII). Bone marrow biopsies were negative in all patients. Overall, eight of 35 patients (23%) had simultaneous biopsy-proven involvement of two MALT-sites: one patient each had lymphoma of parotid and lacrimal gland, conjunctiva and hypopharynx, conjunctiva and skin, lacrimal gland and lung, stomach and colon, and stomach and lung. The remaining two patients had bilateral parotideal lymphoma. Staging work-up was negative for lymph-node involvement in all of these eight patients. The importance of extensive staging in MALT-type lymphoma is emphasized by the demonstration of multiorgan involvement in almost a quarter of patients. In addition, our data suggest that extra-gastrointestinal MALT-type lymphoma more frequently occurs simultaneously at different anatomic sites than MALT-type lymphoma involving the GI-tract. © 2000 Cancer Research Campaign

Keywords:

MALT-type lymphoma, multifocal involvement, staging

Top

References

  1. Berlin C, Berg E and Briskin M (1993) alpha4beta7 intergrin mediates lymphocyte binding to the mucosal vascular addressin MAdCAM-1. Cell 74: 185–195 | Article | PubMed | ISI | ChemPort |
  2. Brandtzaeg P, Farstad I and Haraldsen G (1999) Regional specialization of the mucosal immune system: primed cells do not always home along the same track. Immunol Today 20: 267–277 | Article | PubMed | ISI | ChemPort |
  3. Chan W, Wong N and Chan A (1998) Consistent copy number gain in chromosome 12 in primary diffuse large cell lymphomas of the stomach. Am J Pathol 152: 11–16 | PubMed | ISI | ChemPort |
  4. Du M, Diss TC and Dogan A (1999) Clone specific PCR reveals wide dissemination of gastric MALT lymphoma to the gastrointestinal mucosa. Mod Pathol 12: 135A
  5. Graziadei G, Pruneri G and Carboni N (1998) Low-grade MALT-lymphoma involving multiple mucosal sites and bone marrow. Ann Hematol 76: 81–83
  6. Greiner A, Marx A and Heesemann J (1994) Idiotype idendity in a MALT-type lyphoma and B-cells in Helcobacter-pylori-associated chronic gastritis. Lab Invest 70: 572–578 | PubMed | ISI | ChemPort |
  7. Haim N, Leviov M and Ben-Arieh Y (1995) Intermediate and high-grade gastric non-Hodgkin's lymphoma: a prospective study of non-surgical treatment with primary chemotherapy, with or without radiotherapy. Leuk Lymphoma 17: 321–326
  8. Isaacson PG (1999) Gastric MALT lymphoma: from concept to cure. Ann Oncol 10: 637–645 | Article | PubMed | ISI | ChemPort |
  9. Isaacson PG and Wright DH (1983) Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer, (1983). 52: 1410–1416 | Article | PubMed | ISI | ChemPort |
  10. Isaacson PG and Norton AJ (1994 a) Mucosa-associated lymphoid tissue (MALT) and the MALT-lymphoma concept. In: Extranodal Lymphomas, Isaacson PG, Norton AJ (eds), pp. Churchill Livingstone: Edinburgh5–14
  11. Isaacson PG and Norton AJ (1994 b) Malignant lymphoma of the gastrointestinal tract. In: Extranodal Lymphomas, Isaascson PG, Norton AJ (eds), pp. 15–65, Churchill Livingstone: Edinburgh
  12. Kawamata N, Miki T and Fukuda T (1995) Determination of a common clonal origin of gastric and pulmonary mucosa-associated lymphoid tissue lymphomas presenting five years apart. Intern Med 34: 220–223
  13. Musshoff K (1977) Klinische Stadieneinteilung der Non-Hodgkin Lymphome. Strahlentherapie 153: 218–221 | PubMed | ISI | ChemPort |
  14. Neubauer A, Thiede C and Morgner A (1997) Cure of Helicobacter pylori infection and duration of remission of low-grade gastric mucosa-associated lymphoid tissue lymphoma. J Natl Cancer Inst 89: 1350–1355 | Article | PubMed | ChemPort |
  15. Pileri S, Milani M and Fraternali-Orcioni G (1998) From the REAL-classificatio to the upcoming WHO-scheme: A step towards universal categorization of lymphoma entities?. Ann Oncol 9: 607–612 | Article | PubMed | ISI | ChemPort |
  16. Qin Y, Greiner A and Trunk MJF (1995) Somatic hypermutation in low-grade mucosa-associated lymphoid tissue-type-B-cell lymphoma. Blood 86: 3528–3533 | PubMed | ISI | ChemPort |
  17. Roggero E, Zucca E and Pinotti G (1995) Eradication of Helicobacter pylori infection in primary low-grade gastric lymphoma of the mucosa-associated lymphoid tissue. Ann Intern Med 122: 767–769 | PubMed | ISI | ChemPort |
  18. Sackmann M, Morgner A and Rudolph B (1997) Regression of gastric MALT lymphoma after eradication of Helicobacter pylori is predicted by endosonographic staging. MALT Lymphoma Study Group. Gastroenterology 113: 1087–1090 | Article | PubMed | ISI | ChemPort |
  19. Schechter NR, Portlock Cs and Yahalom JTreatment of mucosa associated lymphoid tissue lymphoma of the stomach with radiation alone. J Clin Oncol 16: 1916–1921
  20. Stephen MR, Farquharson MA and Sharp RA (1998) Sequential MALT lymphomas of the stomach, small intestine and gall bladder. J Clin Pathol 51: 77–79
  21. Thieblemont C, Bastion Y and Berger F (1997) Mucosa-associated lymphoid tissue gastrointestinal and nongastrointestinal lymphoma behavior: Analysis of 108 patients. J Clin Oncol 15: 1624–1630 | PubMed | ISI | ChemPort |
  22. Wotherspoon A, Doglioni C and Isaacson PG (1992) Low-grade gastric B-cell lymphoma of mucosa associated lymphoid tissue (MALT): a multifocal disease. Histopathology 20: 29–34 | Article | PubMed | ISI | ChemPort |
  23. Zucca E, Roggera E and Bertoni F (1997) Primary extranodal non-Hodgkin's lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol 8: 727–737 | PubMed |