PMC8215156_01
(A,B) Gastroscopy revealed multiple erosion and ulcer in gastric body and gastric angle. (C) EUS revealed hypoechoic thickening of the mucosa layer. (D) ME-NBI showed irregular marginal crypt epithelium and subepithelial capillary network. (E) Abdominal computed tomography showed thickening of the wall of gastric body and gastric fundus and mild enhancement, and the surrounding lymph nodes were enlarged. (F-H) The procedure of ESD.
fmed-08-668531-g0001.jpg
PMC8215156_01_fmed-08-668531-g0001.jpg
F1
Gastroscopy revealed multiple erosion and ulcer in gastric body and gastric angle (Figures 1A,B) and biopsy showed atypical lymphocytes and gastric lymphoma was suspected. Endoscopic ultrasonography (EUS) revealed hypoechoic thickening of the mucosa layer (Figure 1C) and magnifying endoscopy with narrow band imaging (ME-NBI) showed irregular marginal crypt epithelium and subepithelial capillary network (Figure 1D), but the second biopsy showed chronic inflammation. Abdominal computed tomography showed thickening of the wall of gastric body and gastric fundus and mild enhancement, and the surrounding lymph nodes were enlarged (Figure 1E). Based on the endoscopic findings, imaging features and repeat insignificant biopsy results, a diagnose of gastric MALT was suspicious and therefore we performed ESD for jumbo biopsy (Figures 1F-H).
(A) The flow cytometry showed that ~23.9% of all the lymphocytes (red cell population) expressed CD19, CD20, CD38, kappa, and did not express lambda, CD10. (B) The flow cytometry of the ESD sample showed that ~39.5% of all the lymphocytes (red cell population) expressed CD19, CD20, kappa, CD38 (partial), and did not express lambda, CD10.
fmed-08-668531-g0002.jpg
PMC8215156_02_fmed-08-668531-g0002.jpg
F2
The flow cytometry of the ESD sample showed that ~39.5% of all the lymphocytes (red cell population) expressed CD19, CD20, kappa, CD38 (partial), and did not express lambda, CD10, which were considered as abnormal monoclonal B lymphocytes (Figure 2B).
(A) Hematoxylin-eosin staining x 200. (B) Immunohistochemistry showed positive reactivity for CD20. (C) Immunohistochemistry showed positive reactivity for CD79a. (D) Immunohistochemistry showed partially positive reactivity for Mum-1. (E) Hematoxylin-eosin staining x 200. (F) Immunohistochemistry showed positive reactivity for CD20. (G) Immunohistochemistry showed positive reactivity for CD79a. (H) Immunohistochemistry showed positive reactivity for Bcl-2.
fmed-08-668531-g0003.jpg
PMC8215156_02_fmed-08-668531-g0003.jpg
F3
The histopathological examination of the ESD sample confirmed the diagnosis of a gastric MALT lymphoma, with diffuse infiltration of small-sized lymphoid cells, which were positive for CD20, CD79a, PAX-5, Bcl-2, Mum-1 (partial), CD21 (partial), CD23 (partial), kappa (partial), and lambda (partial), but negative for CD3, CD5, CD10, CD43, Bcl-6, cyclin D1, c-myc, SOX11, and p53 (Figures 3E-H).
PMC8215156_02
(A) The flow cytometry showed that ~23.9% of all the lymphocytes (red cell population) expressed CD19, CD20, CD38, kappa, and did not express lambda, CD10. (B) The flow cytometry of the ESD sample showed that ~39.5% of all the lymphocytes (red cell population) expressed CD19, CD20, kappa, CD38 (partial), and did not express lambda, CD10.
fmed-08-668531-g0002.jpg
PMC8215156_02_fmed-08-668531-g0002.jpg
F2
The flow cytometry of the ESD sample showed that ~39.5% of all the lymphocytes (red cell population) expressed CD19, CD20, kappa, CD38 (partial), and did not express lambda, CD10, which were considered as abnormal monoclonal B lymphocytes (Figure 2B).
(A) Hematoxylin-eosin staining x 200. (B) Immunohistochemistry showed positive reactivity for CD20. (C) Immunohistochemistry showed positive reactivity for CD79a. (D) Immunohistochemistry showed partially positive reactivity for Mum-1. (E) Hematoxylin-eosin staining x 200. (F) Immunohistochemistry showed positive reactivity for CD20. (G) Immunohistochemistry showed positive reactivity for CD79a. (H) Immunohistochemistry showed positive reactivity for Bcl-2.
fmed-08-668531-g0003.jpg
PMC8215156_02_fmed-08-668531-g0003.jpg
F3
The histopathological examination of the ESD sample confirmed the diagnosis of a gastric MALT lymphoma, with diffuse infiltration of small-sized lymphoid cells, which were positive for CD20, CD79a, PAX-5, Bcl-2, Mum-1 (partial), CD21 (partial), CD23 (partial), kappa (partial), and lambda (partial), but negative for CD3, CD5, CD10, CD43, Bcl-6, cyclin D1, c-myc, SOX11, and p53 (Figures 3E-H).
(A) Gastroscopy revealed erosion and ulcer in greater curvature of gastric antrum. (B) EUS revealed a hypoechoic lesion from mucosa layer, muscularis mucosa layer, and submucosa layer. (C-F) ME-NBI showed irregular marginal crypt epithelium and subepithelial capillary network. (G,H) The procedure of ESD.
fmed-08-668531-g0004.jpg
PMC8215156_02_fmed-08-668531-g0004.jpg
F4
Gastroscopy revealed erosion and ulcer in greater curvature of gastric antrum (Figure 4A) and biopsy showed chronic inflammation. EUS revealed a hypoechoic lesion from mucosa layer, muscularis mucosa layer and submucosa layer (Figure 4B) and ME-NBI showed irregular marginal crypt epithelium and subepithelial capillary network (Figures 4C-F), but the second biopsy showed chronic inflammation and intestinal metaplasia. Based on the endoscopic findings and repeat insignificant biopsy results, we performed ESD for jumbo biopsy (Figures 4G,H).