title: A case of gastric mucosa-associated lymphoid tissue lymphoma in which magnified endoscopy with narrow band imaging was useful in the diagnosis.
abstract: Recently, we reported a case of gastric mucosa-associated lymphoid tissue (MALT) lymphoma presenting with unique vascular features. In the report, we defined the tree-like appearance (TLA) on the images of abnormal blood vessels which resembled branches from the trunk of a tree in the shiny mucosa, in which the glandular structure was lost. The 67-year-old female was diagnosed with gastric MALT lymphoma. The patient received eradication therapy for H. pylori. Conventional endoscopy revealed multiple ill-delineated brownish depressions in the stomach and cobblestone-like mucosa was observed at the greater curvature to the posterior wall of the upper gastric body 7 mo after successful eradication. Unsuccessful treatment of gastric MALT lymphoma was suspected on conventional endoscopy. Conventional endoscopic observations found focal depressions and cobblestone-like appearance, and these lesions were subsequently observed using magnified endoscopy combined with narrow band imaging to identify abnormal vessels presenting with a TLA within the lesions. Ten biopsies were taken from the area where abnormal vessels were present within these lesions. Ten biopsies were also taken from the lesions without abnormal vessels as a control. A total of 20 biopsy samples were evaluated to determine whether the diagnosis of MALT lymphoma could be obtained histologically from each sample. A positive diagnosis was obtained in 8/10 TLA (+) sites and in 2/10 TLA(-) sites. Target biopsies of the site with abnormal blood vessels can potentially improve diagnostic accuracy of gastric MALT lymphoma.
authors.affiliation: Kouichi Nonaka, Keiko Ishikawa, Shin Arai, Masamitsu Nakao, Makoto Nishimura, Osamu Togawa, Yasutoshi Ochiai, Hiroto Kita, Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Nonaka
authors.forename: Keiko
authors.initials: K
authors.lastname: Ishikawa
authors.forename: Shin
authors.initials: S
authors.lastname: Arai
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakao
authors.forename: Michio
authors.initials: M
authors.lastname: Shimizu
authors.forename: Takaki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Koji
authors.initials: K
authors.lastname: Nagata
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Ochiai
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kita