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Case Reports
. 2021 Jun 7:8:668531.
doi: 10.3389/fmed.2021.668531. eCollection 2021.

Gastric Mucosa-Associated Lymphoid Tissue Lymphomas Diagnosed by Jumbo Biopsy Using Endoscopic Submucosal Dissection: A Case Report

Jian Han  1 , Jun Wang  2 , Hua-Ping Xie  1
Affiliations
Case Reports

Gastric Mucosa-Associated Lymphoid Tissue Lymphomas Diagnosed by Jumbo Biopsy Using Endoscopic Submucosal Dissection: A Case Report

Jian Han et al. Front Med (Lausanne). .

Abstract

The stomach is the most common primary site of mucosa-associated lymphoid tissue (MALT) lymphoma, and sometimes the histopathological diagnosis is particularly difficult. An endoscopic forceps biopsy is the primary diagnostic test, but false negative results are very common. Therefore, a jumbo biopsy is essential for accurate diagnosis of clinically suspected cases. Here we diagnosed two cases of gastric MALT lymphomas using endoscopic submucosal dissection (ESD). The first patient was suspected of gastric lymphoma at the first endoscopic forceps biopsy, but the second endoscopic forceps biopsy showed chronic inflammation. The second patient was also firstly diagnosed with chronic inflammation by endoscopic forceps biopsy. Both cases were finally confirmed with the diagnosis of gastric MALT lymphoma by jumbo biopsy using ESD. The application of ESD can provide a new diagnostic strategy for clinically suspicious cases of gastric MALT lymphoma with negative endoscopic forceps biopsy.

Keywords: endoscopic submucosal dissection; flow cytometry; jumbo biopsy; mucosa-associated lymphoid tissue lymphoma; stomach.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(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.
Figure 2
Figure 2
(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.
Figure 3
Figure 3
(A) Hematoxylin-eosin staining × 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 × 200. (F) Immunohistochemistry showed positive reactivity for CD20. (G) Immunohistochemistry showed positive reactivity for CD79a. (H) Immunohistochemistry showed positive reactivity for Bcl-2.
Figure 4
Figure 4
(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.
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