Progression of gastritis to monoclonal B-cell lymphoma with resolution and recurrence following eradication of Helicobacter pylori
S. J. Carlson, H. Yokoo and A. Vanagunas
Gastroenterology Division, Department of Medicine, Northwestern University Medical School, Chicago, IL 60611-3008, USA.
OBJECTIVE: To follow a patient with Helicobacter pylori-associated
gastritis by performing serial endoscopic biopsies to observe the
histologic progression of the gastritis to a monoclonal B-cell lymphoma
with resolution and subsequent recurrence following eradication of H pylori
organisms. DESIGN: A case report of a patient followed over 3 years. MAIN
OUTCOME MEASURES: Characteristics of the gastric mucosa as determined by
histologic and gene rearrangement studies on multiple random biopsies
obtained serially before and after the eradication of H pylori organisms.
RESULTS: A progression from H pylori-associated gastritis through lymphoid
hyperplasia to a monoclonal B-cell lymphoma was observed. With the
techniques used, a resolution of the lymphoma was observed on eradication
of H pylori organisms, with a subsequent recurrence of the lymphoma 15
months later, despite the absence of H pylori organisms. CONCLUSION: The
observations made of this patient support an association between H pylori
and the development of a gastric monoclonal B-cell lymphoma. This lesion
appears to develop in the setting of gastritis and progresses through
lymphoid hyperplasia followed subsequently by the lymphoma. We speculate
that this process is initially antigen driven by the organism and may
subsequently become autonomous as genetic damage is accumulated, so that
eradication of H pylori organisms will lead to regression of the lesion to
the degree that there are autonomously proliferating cells present.
