MALT lymphoma

Last reviewed: 19 Apr 2022
Last updated: 30 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • history of Helicobacter pylori gastritis
  • history of autoimmune disorder
  • age >60 years
  • dyspepsia
  • epigastric discomfort
  • skin lesions
  • red eye ± photophobia
  • painless proptosis, diplopia, motility disturbances of the eye, ptosis, decreased vision
More key diagnostic factors

Other diagnostic factors

  • nausea and/or vomiting
  • GI bleeding
  • fever
  • night sweats
  • weight loss
  • shortness of breath, haemoptysis, cough
  • salivary gland swelling
  • thyroid swelling
  • breast lump
  • focal neurological deficits
  • lymphadenopathy
Other diagnostic factors

Risk factors

  • Helicobacter pylori infection
  • age >60 years
  • autoimmune diseases
  • female sex
  • Chlamydia psittaci infection
  • Campylobacter jejuni infection
  • Borrelia burgdorferi infection
  • hepatitis C virus infection
  • HIV infection
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • blood smear
  • upper GI endoscopy
  • biopsy of affected tissue
  • staging CT scan
  • H pylori serology
  • H pylori stool antigen test
  • LFTs
  • basic metabolic profile
More 1st investigations to order

Investigations to consider

  • bone marrow biopsy
  • immunohistochemistry
  • reverse transcriptase polymerase chain reaction (RT-PCR) or fluorescence in situ hybridisation (FISH)
  • immunoglobulin gene rearrangement studies
  • serum electrophoresis
  • serum LDH
  • serum beta-2 microglobulin
  • 18F-fluorodeoxyglucose (FDG) PET/CT scan
  • endoscopic ultrasound of the stomach
  • double contrast radiography of the GI tract
  • lower GI endoscopy
  • endoscopic otolaryngology
  • CT scan of salivary glands
  • MRI orbit
  • hepatitis C serology
  • hepatitis B serology
  • HIV serology
  • multiple-gated acquisition scan (MUGA)
  • echocardiography
  • ethylenediamine tetra-acetic acid glomerular filtration rate (EDTA GFR)
More investigations to consider

Treatment algorithm

ACUTE

low-grade localised gastric: Helicobacter pylori-positive

low-grade localised gastric: Helicobacter pylori-negative

low-grade advanced gastric

low-grade non-gastric

high-grade histological transformation: gastric or non-gastric

Contributors

Authors

Christopher McNamara, MBBS (Hons), FRACP, FRCPA, FRCPath

Consultant Haematologist

Royal Free Hospital

London

UK

Disclosures

CM declares that he has no competing interests.

Acknowledgements

Dr Christopher McNamara wishes to gratefully acknowledge Dr Rahul Joshi, a previous contributor to this topic. RJ declared that he had no competing interests. Unfortunately, we have since been made aware that Dr Rahul Joshi is deceased.

Peer reviewers

Markus Raderer, MD

Professor of Medicine

Department of Internal Medicine I

Division of Oncology

Medical University Vienna

Austria

Disclosures

MR is an author of a number of references cited in this topic.

Alan Lichtin, MD

Staff Hematologist

Cleveland Clinic Taussig Cancer Center

Cleveland

OH

Disclosures

AL declares that he has no competing interests.

Ian Chau, MD

Consultant Medical Oncologist

Royal Marsden Hospital

Sutton

UK

Disclosures

IC has been reimbursed by Roche Products, the manufacturer of rituximab, for attending several conferences. IC has also served on advisory boards and received honorarium for giving presentations for Roche Products. IC has received research funding from Novartis to conduct academic studies in the treatment of colorectal cancer.

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