Are lymphocytic monoclonality and immunoglobulin heavy chain (IgH) rearrangement premalignant conditions in chronic gastritis?

Normal gastric mucosa is devoid of lymphoid cells. Any increase of lymphocy tes suggests chronic inflammation. Infection with Helicobacter pylori (Hpl is the major cause for nonautoimmune chronic gastritis and induces a mixed cellular response resulting in an acquired lymphoid tissue, or MALT (mucosa -associated lymphoid tissue). Hp has also been implicated in the genesis of gastric MALT-lymphoma. Polymerase chain reaction-based assays to detect th e expansion of monoclonal B-cells have also been used to corroborate the di agnosis. In a considerable number of cases monoclonal B-cells remain detect able in follow-up biopsies, with the lymphoma being in complete histologica l remission. The clinical relevance of this finding is not clear yet. Howev er, there also exist different reports that monoclonal B-cells can be found in gastric biopsies of patients with neither a histological sign nor a pre sent or past history of lymphoma. In the light of these findings we address the question whether B-cell monoclonality can be seen as a premalignant co ndition in chronic gastritis and conclude that as of now the relevance of t he finding of B-cell monoclonality remains unclear. As of now the only and gold standard for the diagnosis of gastric MALT-lymphoma is histopathology. Microsc. Res. Tech. 53:414-418, 2001. (C) 2001 Wiley-Liss, Inc.