Regression of colonic low grade B cell lymphoma of the mucosa associated lymphoid tissue type after eradication of Helicobacter pylori

Background-Lymphoma of the mucosa associated lymphoid tissue (MALT) arising in the stomach has been shown to be related to Helicobacter pylori infecti on, and total regression of gastric lymphoma after successful eradication o f H pylori has consistently been reported. MALT-type lymphoma at other loca lisations, however, has to our knowledge not been linked to H pylori, and e radication of the bacteria has not been studied for management of such lymp homas. Patient/method-A 67 year old man was diagnosed with MALT-type lymphoma simu ltaneously involving the stomach and the colon descendens. In addition to t he presence of MALT-type lymphoma, H pylori associated chronic gastritis wa s diagnosed, and treatment with clarithromycin, metronidazole, and omeprazo le was initiated, resulting in its successful eradication. Results-Follow up performed four months later showed regression of the colo nic manifestation, whereas the gastric lymphoma did not respond to antibiot ic treatment, as assessed by regular follow up for 14 months, in spite of i ts restriction to mucosa and submucosa. The patient was therefore treated w ith oral cyclophosphamide (100 mg a day) resulting in partial remission aft er seven months of continuous treatment. Because of the presence of residua l lymphoma, additional irradiation was performed, which led to complete rem ission of the gastric lymphoma. The patient remains in complete remission 4 0 months after diagnosis and 26 months after initiation of treatment. Conclusion-In the case of concurrent gastric and intestinal low grade MALT- type lymphoma, H pylori eradication may cause regression of the intestinal lesion.