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Changes in the endoscopic image of gastric mucosa-associated lymphoid tissue (MALT) and course of treatment during long observation periods. The yellow arrowheads indicate the sites corresponding to each endoscopy. Biopsy tests indicated repeated relapse and remission of MALT lymphoma. The blue arrowheads indicate areas of MALT lymphoma relapse from other biopsy sites. CHOP: cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone, R: rituximab, R-Cd: rituximab, cladribine, RF: rituximab, fludarabine, RB: rituximab, bendamustine
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However, no additional therapy was administered because the other lesions showed no residual lymphoma (Fig. 1).
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A: Endoscopic image far from the lesion with white light. Neither atrophy nor intestinal metaplasia was observed. B: Endoscopic image close to the lesion. C: The area became clearer with indigo carmine dye spraying. D: The redness of the tumor, when observed with linked-color imaging, became clearer due to the greater contrast with the surrounding non-cancerous area.
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EGD revealed a reddish elevated lesion with an irregular surface that corresponded to the area of scarring on the fundus (Fig. 2A, B). Indigo carmine dye spraying revealed more distinct borders than conventional endoscopy (Fig. 2C). The lesion appeared bright red with LCI and was well contrasted with the surrounding gastric mucosa, creating a distinct boundary (Fig. 2D).
A: Endoscopic image close to the lesion with white light. B: The different-sized glandular structures were confirmed with magnifying narrow-band imaging (NBI). The dilated blood vessels were also visible. C: A tree-like appearance was observed with magnifying NBI at a different site.
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Magnifying narrow-band imaging (NBI) endoscopy revealed several findings, including glandular structures of varying sizes, pruned blood vessels, and dilated blood vessels in the deeper mucosa (Fig. 3).
A: Histology of the collision tumors of well-differentiated tubular adenocarcinoma and MALT lymphoma. 20x magnification with Hematoxylin and Eosin staining. B: Histology of the collision tumors of well-differentiated tubular adenocarcinoma and MALT lymphoma. 20x magnification with AE1/AE3 staining. C: Histology of the collision tumors of well-differentiated tubular adenocarcinoma and MALT lymphoma. 20x magnification with CD20 staining.
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Aside from gastric cancer, histology also revealed invasion by the MALT lymphoma, which was primarily limited to the submucosa (Fig. 5B, C).