title: Gastric lymphoma: the revolution of the past decade.
abstract: BACKGROUND
  Gastric MALT type lymphomas are distinct lymphomas that may develop after chronic antigenic stimulation caused by infection with Helicobacter pylori. An early antigen-dependent phase precedes the development of an antigen-independent phase.
  
  
  METHODS
  Narrative review.
  
  
  RESULTS
  The causative relationship between a chronic H. pylori infection and gastric MALT lymphomas has been based on epidemiological, histological, experimental and therapeutic studies. H. pylori eradication leads to a histological remission in +/- 70% of patients in early stage low-grade MALT lymphoma. There is no basis for therapeutic consequences in the case of persistent monoclonality. Full thickness invasion of the gastric wall and lymph node involvement and/or high-grade lymphoma denote the transition to an antigen-independent phase and calls for conventional treatment modalities. Molecular findings show a specific translocation in low-grade MALT lymphomas: t(11,18) and nuclear expression of bcl-10 that are highly indicative of the transition of the antigen-dependent into the antigen-independent phase. Other chromosomal and molecular findings are probably also involved.
  
  
  CONCLUSIONS
  The multistep pathogenesis of chronic H. pylori gastritis into low-grade gastric MALT lymphoma and tumour progression to a higher stage and grade are characterized by multiple molecular biological events. Antigen-dependency during the early phase of this malignancy is proven by the results of H. pylori eradication.
authors.affiliation: Dept. of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam. h.boot@nki.nl
authors.forename: H
authors.initials: H
authors.lastname: Boot
authors.forename: D
authors.initials: D
authors.lastname: de Jong
mesh_terms: D002908:Chronic Disease; D005753:Gastric Mucosa / Q000276:immunology / Q000473:pathology; D005756:Gastritis / Q000150:complications / Q000276:immunology / Q000628:therapy; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000276:immunology / Q000628:therapy; D016480:Helicobacter pylori; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000209:etiology / Q000276:immunology / Q000628:therapy; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000209:etiology / Q000276:immunology / Q000628:therapy