B-cell monoclonality in Helicobacter pylori-associated chronic atrophic gastritis.
B-cell monoclonality has been reported not only in gastric lymphoma, but also in 1.3-21% of Helicobacter pylori-associated chronic gastritis (Hp-CG) cases. The aim of this study was to determine the significance of B-cell monoclonality in Hp-CG. We examined 134 gastric biopsy specimens from 99 patients with Hp-CG. The density of Hp, polymorphonuclear neutrophil activity, chronic inflammation, glandular atrophy, and intestinal metaplasia (IM) were scored according to the updated Sydney System. B-cell monoclonality was analyzed for immunoglobulin heavy chain gene rearrangement using polymerase chain reaction amplification. B-cell monoclonality was detected in 6% of informative samples. B-cell monoclonality was found in 18% of the samples from Hp-CG patients with marked glandular atrophy but in none of the samples from Hp-CG patients with none to moderate glandular atrophy. Monoclonality was also detected in 20% of the samples from Hp-CG patients with marked IM, in 11% of the samples from Hp-CG patients with moderate IM, and in none of the samples from Hp-CG patients without IM. Therefore, B-cell monoclonality was significantly more frequent in Hp-CG patients with marked glandular atrophy than in Hp-CG patients with none to moderate atrophy. It was also more significantly frequent in Hp-CG patients with moderate or marked IM than in Hp-CG patients without IM (P < 0.05). Of 35 Hp-CG patients, 26 (74%) had identical B-cell populations in the antrum and the corpus, and all were polyclonal. The remaining nine (26%) Hp-CG patients had B-cell populations that differed in the antrum and the corpus. Four of the nine (44%) showed monoclonal B-cell populations in at least one gastric biopsy specimen. There were no patients with monoclonal B-cell populations in both the antrum and the corpus. These data suggest that glandular atrophy and IM in gastric biopsy specimens may be markers for gastric mucosa-associated lymphoid tissue (MALT) lymphoma-genesis and that multiple gastric biopsy specimens from both the antrum and the corpus may be needed to assess the risk of gastric MALT lymphoma.
Hiyama
T
T
First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasusmi, Minami-ku, Hiroshima, 734-8551, Japan. t-hiyama@mcai.med.hiroshima-u.ac.jp
Haruma
K
K
Kitadai
Y
Y
Miyamoto
M
M
Tanaka
S
S
Yoshihara
M
M
Sumii
K
K
Shimamoto
F
F
Kajiyama
G
G
D001402:B-Lymphocytes / Q000473:pathology*; D001706:Biopsy; D002908:Chronic Disease; D005757:Gastritis, Atrophic / Q000276:immunology / Q000473:pathology*; D015321:Gene Rearrangement; D016481:Helicobacter Infections / Q000276:immunology / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000209:etiology*; D016133:Polymerase Chain Reaction
D007143:Immunoglobulin Heavy Chains