SEQUENTIAL MALT LYMPHOMAS OF THE STOMACH, SMALL-INTESTINE, AND GALL-BLADDER

Low grade lymphomas of mucosa associated lymphoid tissue (MALT) are in dolent neoplasms that, although tending to remain localised for many y ears, may spread to other mucosal sites. A 53 year old woman treated b y total gastrectomy for low grade MALT lymphoma of the stomach develop ed a recurrence in the small bowel 18 years later, and a further recur rence involving the gall bladder after three years in complete clinica l remission after chemotherapy. In situ hybridisation showed that the small intestine and gall bladder recurrences had the same pattern of l ight chain restriction. Tumour from all three sites was shown to be de rived from a single clone by the demonstration of an identical immunog lobulin heavy chain gene rearrangement by the polymerase chain reactio n. The case illustrates the propensity of MALT lymphomas to ''home'' t o mucosal sites and gives an insight into their behaviour over an exte nded follow up.