PMC5832122_01
Esophagogastroduodenoscopy images. Slightly elevated, whitish lesions are observed in the gastric body ((a) arrows). Magnifying endoscopic observation with white light (b) and with narrow-band imaging (c) reveals that the gastric surface epithelium is swollen, but the structure is not destroyed or diminished. Whitish area is emphasized after indigo carmine spraying (d).
CRIGM2018-8054284.001.jpg
PMC5832122_01_CRIGM2018-8054284.001.jpg
fig1
Esophagogastroduodenoscopy (GIF-H260Z; Olympus, Tokyo, Japan) showed slightly elevated, whitish lesions in the gastric body (Figure 1(a)). Magnifying endoscopic observation with white light (Figure 1(b)) and with narrow-band imaging (Figure 1(c)) revealed that the gastric surface epithelium was swollen, but the structure was not destroyed or diminished.
Pathological images. Hematoxylin and eosin staining shows dense, diffuse infiltration of small-to-medium-sized monocytoid cells and plasma cells (a, b) and multiple Dutcher bodies ((c) arrows).
CRIGM2018-8054284.002.jpg
PMC5832122_01_CRIGM2018-8054284.002.jpg
fig2
Biopsy samples from the gastric lesions showed dense, diffuse infiltration of small-to-medium-sized monocytoid cells and plasma cells and multiple Dutcher bodies (Figure 2).
Pathological images with immunostaining. The infiltrating cells are positive for CD20 (a) and BCL2 (b), while they are negative for CD3 (c), CD10 (d), and cyclin D1 (e). In situ hybridization for immunoglobulin light chains shows positive results for immunoglobulin light chain kappa (f) and negative results for light chain lambda (g).
CRIGM2018-8054284.003.jpg
PMC5832122_01_CRIGM2018-8054284.003.jpg
fig3
Immunohistochemistry analysis showed that the infiltrating cells were positive for CD20 and BCL2, while they were negative for CD3, CD10, and cyclin D1 (Figure 3). In situ hybridization for immunoglobulin light chains showed expression of monoclonal immunoglobulin light chain kappa in these cells (Figures 3(f) and 3(g)).
Fluorescence in situ hybridization image. Analysis for t(11;18)(q21;q21) translocation reveals no fusion genes of BIRC3-MALT1, although extra copies of MALT1 are identified, indicating trisomy of chromosome 18.
CRIGM2018-8054284.004.jpg
PMC5832122_01_CRIGM2018-8054284.004.jpg
fig4
Fluorescence in situ hybridization (FISH) analysis for t(11;18)(q21;q21) translocation revealed no fusion genes of BIRC3-MALT1, although extra copies of MALT1 were identified in 32.0% of the monocytoid cells (Figure 4), indicating trisomy of chromosome 18.
Esophagogastroduodenoscopy images after treatment. Three months after successful eradication of H. pylori, the whitish lesions disappeared.
CRIGM2018-8054284.005.jpg
PMC5832122_01_CRIGM2018-8054284.005.jpg
fig5
Esophagogastroduodenoscopy performed three months after successful eradication of H. pylori revealed that the whitish lesions had disappeared (Figure 5).