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Gastrointestinal lymphoma

  • Lesion

The stomach is the commonest place outside the lymph nodes for lymphoma; many arise from lymphoid tissue induced by H. pylori.

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What it is

Extranodal lymphomas arise most often in the gut, especially the stomach. The normal stomach has no organized lymphoid tissue; chronic H. pylori gastritis induces it, and an indolent extranodal marginal-zone B-cell lymphoma (MALT lymphoma, or MALToma) can emerge from it. Some MALT lymphomas regress after the bacterium is eradicated. Other gut lymphomas include diffuse large B-cell lymphoma, EBV-driven lymphoproliferations in transplant recipients and enteropathy-associated T-cell lymphoma in coeliac disease.

Structure

  • Endoscopy: thick folds, erosions or ulcers that look like gastritis.
  • Small bowel lymphoma can form many small serosal nodules or diffusely thicken the wall.

Step by step

  1. H. pylori infection induces lymphoid follicles in the gastric mucosa.
  2. Bacterial antigens stimulate T cells, which help polyclonal B cells to grow.
  3. A B-cell clone gains independence, often through a translocation activating NF-κB.
  4. The clone invades glands (lymphoepithelial lesions) and spreads in the mucosa.
  5. Further mutations may transform it into diffuse large B-cell lymphoma.

Markers

  • CD20+
  • CD5−
  • CD10−
  • CD43±
  • Kappa or lambda restriction

Clinical notes

  • Symptoms resemble gastritis: dyspepsia and epigastric pain, sometimes bleeding and weight loss.
  • Iatrogenic immunosuppression (for example after transplantation) favours EBV-positive B-cell proliferations in the gut, where drug levels are highest.

Test yourself

Think of the answer, then tap the question to see it.

What is the most common translocation in gastric MALT lymphoma?

t(11;18)(q21;q21), which creates an API2-MALT1 fusion that activates NF-κB.

What is a lymphoepithelial lesion?

Neoplastic lymphocytes infiltrating and damaging gastric glands, characteristic of MALT lymphoma.

Which lymphoma complicates long-standing coeliac disease?

Enteropathy-associated T-cell lymphoma, derived from intraepithelial T lymphocytes.

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: Helicobacter Pylori (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.