AI Summary & Key Takeaways
AI InsightMultiple large endoscopic biopsy specimens should be repeated and pathologist should be warned of the probability of MALT lymphoma when ultrasound reveals a thickened mucosal layer.
📌 3 Key Takeaways
Abstract
To investigate the typical features of gastric MALT lymphoma on endoscopic ultrasonography and to demonstrate its usefulness in the diagnosis of this disease. Methods:Five patients with gastric MALT lymphoma (three low grade, two high grade) who underwent EUS examination between October 1995 and November 1996 were included in this study. Four patients were not diagnosed as gastric MALT lymphoma prior to endoscopic ultrasonography. The diagnoses in these patients were malignant lymphoma, gastric medullar carcinoma, infiltrative carcinoma and chronic gastritis. Only one case was diagnosed as high grade MALT lymphoma before ultrasound examination. Multiple endoscopic large forceps biopsies were obtained after the ultrasound examination in which MALT lymphoma was suspected and the diagnoses were confirmed with histopathological examination. Results: Endoscopic ultrasound showed abnormal thickening of the second hypoechoic ultrasound layer corresponding to the deep mucosa and muscularis mucosa in three cases with low-grade MALT lymphoma. The echogenity of the infiltrated area was more hypoechoic compared to the neighboring area. The submucosa, muscularis propria and serosa were normal. The five-layered wall structure was well-preserved in all cases with low-grade MALT lymphoma. Ultrasound showed a thickened mucosa and slightly enlarged submucosa in one and enlargement of the second, third and fourth ultrasound layer in the second case with high-grade MALT lymphoma.. The gastric wall structure was well and moderately preserved in the first and second case respectively. Conclusion: Endoscopic ultrasound is useful in the diagnosis of patients with gastric MALT lymphoma. Although enlargement of the mucosal layer is observed in various gastric diseases, MALT lymphoma should be considered as one of the possibilities. Multiple large endoscopic biopsy specimens should be repeated and pathologist should be warned of the probability of MALT lymphoma when ultrasound reveals a thickened mucosal layer.
Özet
MALT lenfoma ve endosonografik bulgularını incelemek ve tanıda endoskopik ultrasonografinin yararlılığını göstermek.Yöntem: Ekim 1995 ve Kasım 1996 tarihleri arasında Türkiye Yüksek İhtisas Hastanesi, Gastroenteroloji Kliniği'nde endoskopik ultrasonografi muayenesi yapılan 5 MALT lenfomalı hasta bu çalışmaya alınmıştır. Olguların üçü erkek, ikisi kadın olup, ortalama yaş 55 (38-67 yıl) idi. Tümünde Helicocbacter pylori pozitifti. Endoskopik ultrasonografi muayenesi öncesi olgulara bir MALT lenfoma hariç, gastrit, infiltratif karsinoma, meduller karsinoma ve malign lenfoma tanıları konmuştu. Endoskopik ultrasonografi muayenesinde MALT lenfoma düşünülmesi üzerine lezyonlardan alınan çok sayıda forseps biopsi örnekleri daha ayrıntılı histopatolojik incelemeye tabi tutulmuş ve MALT lenfoma tanısı doğrulanmıştır. Bulgular: "Low-grade" MALT lenfomalı olguların endosonografik incelemelerinde mukozaya karşılık gelen ikinci hipoekoik tabaka belirgin olarak kalınlaşmıştı. Submukoza, muskularis propria normaldi. Mide duvar bütünlüğü bozulmamıştı."High grade" MALT lenfomalı bir olguda mukoza ve submukoza, diğerinde mukoza submukoza ve muskularis propria kalınlaşmıştı. Mide duvar bütünlüğü son olguda orta derecede korunmuştu.Sonuç:Endoskopik ultrasonografinin incelemesinde mukoza tabakasının kalınlaştığı durumlarda MALT lenfoma akla getirilmelidir, Tanının konması için çok sayıda biopsi örneği alınmalı ve patologa MALT lenfoma ihtimali bildirilmelidir.