Prevalence and Implications of Bone Marrow Involvement in Patients with Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Background/Aims: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is an uncommon disease. Bone marrow involvement is reported even in patients with only a mucosal lesion. We evaluated the prevalence and risk factors of marrow involvement and its implications for diagnosis and treatment. Methods: In total, 132 patients who were diagnosed with gastric MALT lymphoma at the National Cancer Center in Korea between January 2001 and December 2016 were enrolled in the study. The patient data were collected and analyzed retrospectively. Results: Of the 132 patients, 47 (35.6%) were male, with a median age of 52 years (range, 17 to 81 years). The median follow-up duration was 48.8 months (range, 0.5 to 169.9 months). Helicobacter pylori infection was detected in 82 patients (62.1%). Most patients (80.3%) had stage IE1 according to the modified Ann Arbor staging system. Ninety-two patients underwent bone marrow evaluation, and four patients (4.3%) had marrow involvement. Of these patients, one presented with abdominal lymph node involvement, while the other three had stage IE1 disease if marrow involvement was disregarded. All three patients had no significant symptoms and were monitored after local treatment without evidence of disease aggravation. Conclusions: Bone marrow involvement was found in 4.3% of the patients with gastric MALT lymphoma. Bone marrow examination may be deferred because marrow involvement does not change the treatment options or outcome in gastric MALT lymphoma confined to the stomach wall.
Abstract
Background/Aims: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is an uncommon disease. Bone marrow involvement is reported even in patients with only a mucosal lesion. We evaluated the prevalence and risk factors of marrow involvement and its implications for diagnosis and treatment. Methods: In total, 132 patients who were diagnosed with gastric MALT lymphoma at the National Cancer Center in Korea between January 2001 and December 2016 were enrolled in the study. The patient data were collected and analyzed retrospectively. Results: Of the 132 patients, 47 (35.6%) were male, with a median age of 52 years (range, 17 to 81 years). The median follow-up duration was 48.8 months (range, 0.5 to 169.9 months). Helicobacter pylori infection was detected in 82 patients (62.1%). Most patients (80.3%) had stage IE1 according to the modified Ann Arbor staging system. Ninety-two patients underwent bone marrow evaluation, and four patients (4.3%) had marrow involvement. Of these patients, one presented with abdominal lymph node involvement, while the other three had stage IE1 disease if marrow involvement was disregarded. All three patients had no significant symptoms and were monitored after local treatment without evidence of disease aggravation. Conclusions: Bone marrow involvement was found in 4.3% of the patients with gastric MALT lymphoma. Bone marrow examination may be deferred because marrow involvement does not change the treatment options or outcome in gastric MALT lymphoma confined to the stomach wall.
참고문헌 (32)
- Harris NL, "A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group", Blood, 84, pp.1361~1392 (1994)
- Swerdlow SH, "The 2016 revision of the World Health Organization classification of lymphoid neoplasms", Blood, 127, pp.2375~2390 (2016)[DOI]
- "A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma: the non-Hodgkin's lymphoma classification project", Blood, 89, pp.3909~3918 (1997)
- Wotherspoon AC, "Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma", Lancet, 338, pp.1175~1176 (1991)[DOI]
- Hyjek E, "Primary B-cell lymphoma of salivary glands and its relationship to myoepithelial sialadenitis", Hum Pathol, 19, pp.766~776 (1988)[DOI]
- Hyjek E, "Primary B cell lymphoma of the thyroid and its relationship to Hashimoto's thyroiditis", Hum Pathol, 19, pp.1315~1326 (1988)[DOI]
- Thieblemont C, "Mucosa-associated lymphoid tissue gastrointestinal and nongastrointestinal lymphoma behavior: analysis of 108 patients", J Clin Oncol, 15, pp.1624~1630 (1997)[DOI]
- Zucca E, "Emerging role of infectious etiologies in the pathogenesis of marginal zone B-cell lymphomas", Clin Cancer Res, 20, pp.5207~5216 (2014)[DOI]
- Isaacson PG, "The MALT lymphoma concept updated", Ann Oncol, 6, pp.319~320 (1995)[DOI]
- Zucca E, "The gastric marginal zone B-cell lymphoma of MALT type", Blood, 96, pp.410~419 (2000)
- Zucca E, "The management of nongastric MALT lymphomas", Oncology (Williston Park), 28, pp.86~93 (2014)
- Lee MH, "Two cases of gastric low-grade mucosa-associated lymphoid tissue lymphoma involving bone marrow", Korean J Gastroenterol, 36, pp.695~700 (2000)
- 민병훈, "Limited Role of Bone Marrow Aspiration and Biopsy in the Initial Staging Work-up of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma in Korea", Gut and Liver, 8(6), pp.637~642 (2014), 거트앤리버 소화기연관학회협의회
- Park JY, "Bone marrow involvement is rare in superficial gastric mucosa-associated lymphoid tissue lymphoma", Dig Liver Dis, 48, pp.81~86 (2016)[DOI]
- "B-cell lymphoma version 1. 2017, NCCN guidelines" (2017)[URL]
- Zucca E, "Gastric marginal zone lymphoma of MALT type: ESMO clinical practice guidelines for diagnosis, treatment and follow-up", Ann Oncol, 24(Suppl 6), pp.vi144~vi148 (2013)
- Ruskone-Fourmestraux A, "EGILS consensus report: gastric extranodal marginal zone B-cell lymphoma of MALT", Gut, 60, pp.747~758 (2011)[DOI]
- Wotherspoon AC, "Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori", Lancet, 342, pp.575~577 (1993)[DOI]
- Konda B, "Safe and successful bone marrow biopsy: an anatomical and CT-based cadaver study", Am J Hematol, 89, pp.943~946 (2014)[DOI]
- Won D, "Subtle CD20 positivity in the bone marrow of a patient who has a mucosa-associated lymphoid tissue lymphoma should not be regarded as evidence of involvement in the bone marrow", Histopathology, 62, pp.397~405 (2013)[DOI]
- Radaszkiewicz T, "Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue: factors relevant to prognosis", Gastroenterology, 102, pp.1628~1638 (1992)[DOI]
- Ruskone-Fourmestraux A, "Paris staging system for primary gastrointestinal lymphomas", Gut, 52, pp.912~913 (2003)[DOI]
- Choi D, "Gastric mucosa-associated lymphoid tissue lymphoma: helical CT findings and pathologic correlation", AJR Am J Roentgenol, 178, pp.1117~1122 (2002)[DOI]
- Copie-Bergman C, "Proposal for a new histological grading system for post-treatment evaluation of gastric MALT lymphoma", Gut, 52, pp.1656~ (2003)[DOI]
- Yang HJ, "Clinical characteristics of primary gastric lymphoma detected during screening for gastric cancer in Korea", J Gastroenterol Hepatol, 31, pp.1572~1583 (2016)[DOI]
- 김진만, "WHO Classification of Malignant Lymphomas in Korea: Report of the Third Nationwide Study", Journal of Pathology and Translational Medicine, 45(3), pp.254~260 (2011), 대한병리학회
- Chung SJ, "Long-term clinical outcome of helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma is comparable to that of H. pylori-positive lymphoma", J Clin Gastroenterol, 43, pp.312~317 (2009)[DOI]
- Nakamura S, "Helicobacter pylorinegative gastric mucosa-associated lymphoid tissue lymphoma: a clinicopathologic and molecular study with reference to antibiotic treatment", Cancer, 107, pp.2770~2778 (2006)[DOI]
- Gong EJ, "Bone marrow involvement is not associated with the clinical outcomes of gastric mucosa-associated lymphoid tissue lymphoma", Scand J Gastroenterol, 51, pp.942~948 (2016)[DOI]
- Conlan MG, "Bone marrow involvement by non-Hodgkin's lymphoma: the clinical significance of morphologic discordance between the lymph node and bone marrow. Nebraska Lymphoma Study Group", J Clin Oncol, 8, pp.1163~1172 (1990)[DOI]
- Thieblemont C, "Clinical presentation and management of marginal zone lymphomas", Hematology Am Soc Hematol Educ Program, 2005, pp.307~313 (2005)
- Montalban C, "Gastric B-cell mucosaassociated lymphoid tissue (MALT) lymphoma: clinicopathological study and evaluation of the prognostic factors in 143 patients", Ann Oncol, 6, pp.355~362 (1995)[DOI]