Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Spectrum of Findings at Double-Contrast Gastrointestinal Examination with Pathologic Correlation1
Su Kyung An, MD,
Joon Koo Han, MD,
Young Hoon Kim, MD,
Ah Young Kim, MD,
Byung Ihn Choi, MD,
Young A Kim, MD and
Chul Woo Kim, MD
1 From the Departments of Radiology (S.K.A., J.K.H., Y.H.K., A.Y.K., B.I.C.) and Pathology (Y.A.K., C.W.K.), Seoul National University College of Medicine, 28 Yongon-dong, Chongno-Gu, Seoul 110-744, Korea; and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Korea (S.K.A., J.K.H., Y.H.K., A.Y.K., B.I.C.). Presented as an education exhibit at the 2000 RSNA scientific assembly. Received March 23, 2001; revision requested May 3; final revision received July 30; accepted August 2. Address correspondence to J.K.H. (e-mail: hanjk@radcom.snu.ac.kr).
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Figure 1a. Low-grade gastric MALT lymphoma with multiple shallow ulcers in a 31-year-old woman. The probable diagnosis in this patient was gastritis. (a) Spot radiograph of the gastric antrum shows multiple erosions (open arrows) with diffuse enlargement of the areae gastricae (solid arrows). (b) Photograph of the resected specimen shows multiple shallow ulcers (arrows) in the gastric body and antrum. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows lymphoma cells (blue stain) diffusely infiltrating the mucosa (m) and submucosa (sm).
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Figure 1b. Low-grade gastric MALT lymphoma with multiple shallow ulcers in a 31-year-old woman. The probable diagnosis in this patient was gastritis. (a) Spot radiograph of the gastric antrum shows multiple erosions (open arrows) with diffuse enlargement of the areae gastricae (solid arrows). (b) Photograph of the resected specimen shows multiple shallow ulcers (arrows) in the gastric body and antrum. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows lymphoma cells (blue stain) diffusely infiltrating the mucosa (m) and submucosa (sm).
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Figure 1c. Low-grade gastric MALT lymphoma with multiple shallow ulcers in a 31-year-old woman. The probable diagnosis in this patient was gastritis. (a) Spot radiograph of the gastric antrum shows multiple erosions (open arrows) with diffuse enlargement of the areae gastricae (solid arrows). (b) Photograph of the resected specimen shows multiple shallow ulcers (arrows) in the gastric body and antrum. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows lymphoma cells (blue stain) diffusely infiltrating the mucosa (m) and submucosa (sm).
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Figure 2a. High-grade gastric MALT lymphoma with a background of low-grade MALT lymphoma in a 78-year-old woman. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a large, deep ulcer (solid arrows) in the posterior wall of the antrum. The convergence of thickened folds (open arrows) is disorganized. (b) Photograph of the resected specimen shows the ulcer (solid arrows) and the disorganized convergent rugae (open arrows).
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Figure 2b. High-grade gastric MALT lymphoma with a background of low-grade MALT lymphoma in a 78-year-old woman. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a large, deep ulcer (solid arrows) in the posterior wall of the antrum. The convergence of thickened folds (open arrows) is disorganized. (b) Photograph of the resected specimen shows the ulcer (solid arrows) and the disorganized convergent rugae (open arrows).
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Figure 3a. Low-grade gastric MALT lymphoma with masses in a 71-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph from a UGI examination shows a large, well-circumscribed, lobulated mass in the gastric fundus (arrows). (b) Compression spot radiograph shows a small, polypoid mass in the greater curvature of the gastric body (arrow). (c) Photograph from endoscopy shows the large mass protruding from the fundus (solid arrows) and the small polyp in the gastric body (open arrow).
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Figure 3b. Low-grade gastric MALT lymphoma with masses in a 71-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph from a UGI examination shows a large, well-circumscribed, lobulated mass in the gastric fundus (arrows). (b) Compression spot radiograph shows a small, polypoid mass in the greater curvature of the gastric body (arrow). (c) Photograph from endoscopy shows the large mass protruding from the fundus (solid arrows) and the small polyp in the gastric body (open arrow).
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Figure 3c. Low-grade gastric MALT lymphoma with masses in a 71-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph from a UGI examination shows a large, well-circumscribed, lobulated mass in the gastric fundus (arrows). (b) Compression spot radiograph shows a small, polypoid mass in the greater curvature of the gastric body (arrow). (c) Photograph from endoscopy shows the large mass protruding from the fundus (solid arrows) and the small polyp in the gastric body (open arrow).
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Figure 4a. Low-grade gastric MALT lymphoma with a mass, an associated central ulcer, and another ulcer in an 80-year-old man. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a well-demarcated mass (solid arrows) with a central ulcer (u) and an adjacent filling defect (open arrow) with converging folds in the antrum. (Reprinted, with permission, from reference 18.) (b) Photograph of the resected specimen shows the mass (solid arrow) and the central ulcer (u) (the so-called bull’s-eye appearance) in the antrum. Another ulcer (open arrow) is accompanied by a small mass, which caused the filling defect seen in a. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows extension of tumor cells (blue stain) to the muscle layer. m = mucosa, pm = proper muscle, sm = submucosa. (d) Higher-power photomicrograph (x40) of the area in the top left corner of c shows normal gastric mucosa on the left and replacement by lymphoma cells on the right.
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Figure 4b. Low-grade gastric MALT lymphoma with a mass, an associated central ulcer, and another ulcer in an 80-year-old man. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a well-demarcated mass (solid arrows) with a central ulcer (u) and an adjacent filling defect (open arrow) with converging folds in the antrum. (Reprinted, with permission, from reference 18.) (b) Photograph of the resected specimen shows the mass (solid arrow) and the central ulcer (u) (the so-called bull’s-eye appearance) in the antrum. Another ulcer (open arrow) is accompanied by a small mass, which caused the filling defect seen in a. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows extension of tumor cells (blue stain) to the muscle layer. m = mucosa, pm = proper muscle, sm = submucosa. (d) Higher-power photomicrograph (x40) of the area in the top left corner of c shows normal gastric mucosa on the left and replacement by lymphoma cells on the right.
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Figure 4c. Low-grade gastric MALT lymphoma with a mass, an associated central ulcer, and another ulcer in an 80-year-old man. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a well-demarcated mass (solid arrows) with a central ulcer (u) and an adjacent filling defect (open arrow) with converging folds in the antrum. (Reprinted, with permission, from reference 18.) (b) Photograph of the resected specimen shows the mass (solid arrow) and the central ulcer (u) (the so-called bull’s-eye appearance) in the antrum. Another ulcer (open arrow) is accompanied by a small mass, which caused the filling defect seen in a. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows extension of tumor cells (blue stain) to the muscle layer. m = mucosa, pm = proper muscle, sm = submucosa. (d) Higher-power photomicrograph (x40) of the area in the top left corner of c shows normal gastric mucosa on the left and replacement by lymphoma cells on the right.
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Figure 4d. Low-grade gastric MALT lymphoma with a mass, an associated central ulcer, and another ulcer in an 80-year-old man. The probable diagnosis was advanced gastric carcinoma. (a) Compression spot radiograph shows a well-demarcated mass (solid arrows) with a central ulcer (u) and an adjacent filling defect (open arrow) with converging folds in the antrum. (Reprinted, with permission, from reference 18.) (b) Photograph of the resected specimen shows the mass (solid arrow) and the central ulcer (u) (the so-called bull’s-eye appearance) in the antrum. Another ulcer (open arrow) is accompanied by a small mass, which caused the filling defect seen in a. (c) Low-power photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows extension of tumor cells (blue stain) to the muscle layer. m = mucosa, pm = proper muscle, sm = submucosa. (d) Higher-power photomicrograph (x40) of the area in the top left corner of c shows normal gastric mucosa on the left and replacement by lymphoma cells on the right.
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Figure 5a. High-grade gastric MALT lymphoma with a mass and rugal thickening in a 64-year-old man. The probable diagnosis was lymphoma. (a) Spot radiograph shows a well-demarcated mass (solid arrows) in the antrum and disorganized thickened folds (open arrows) that are primarily proximal to the mass. (b) Photograph of the resected specimen shows disorganization of the thickened rugae (black arrows) proximal to the mass (white arrows). (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows severe destruction of gastric glands by high-grade lymphoma cells.
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Figure 5b. High-grade gastric MALT lymphoma with a mass and rugal thickening in a 64-year-old man. The probable diagnosis was lymphoma. (a) Spot radiograph shows a well-demarcated mass (solid arrows) in the antrum and disorganized thickened folds (open arrows) that are primarily proximal to the mass. (b) Photograph of the resected specimen shows disorganization of the thickened rugae (black arrows) proximal to the mass (white arrows). (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows severe destruction of gastric glands by high-grade lymphoma cells.
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Figure 5c. High-grade gastric MALT lymphoma with a mass and rugal thickening in a 64-year-old man. The probable diagnosis was lymphoma. (a) Spot radiograph shows a well-demarcated mass (solid arrows) in the antrum and disorganized thickened folds (open arrows) that are primarily proximal to the mass. (b) Photograph of the resected specimen shows disorganization of the thickened rugae (black arrows) proximal to the mass (white arrows). (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows severe destruction of gastric glands by high-grade lymphoma cells.
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Figure 6a. High-grade gastric MALT lymphoma with rugal thickening in a 45-year-old man. The probable diagnosis was lymphoma. (a) Spot radiograph shows thickened nodular folds (arrows) in the greater curvature of the gastric body. No abnormal finding besides rugal thickening was observed in the resected specimen. (b) Low-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows the characteristic lymphoepithelial lesions formed by invasion of individual glands (arrows) or surface epithelium (arrowheads) by high-grade lymphoma cells that displace or destroy the glandular epithelium.
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Figure 6b. High-grade gastric MALT lymphoma with rugal thickening in a 45-year-old man. The probable diagnosis was lymphoma. (a) Spot radiograph shows thickened nodular folds (arrows) in the greater curvature of the gastric body. No abnormal finding besides rugal thickening was observed in the resected specimen. (b) Low-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows the characteristic lymphoepithelial lesions formed by invasion of individual glands (arrows) or surface epithelium (arrowheads) by high-grade lymphoma cells that displace or destroy the glandular epithelium.
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Figure 7a. Low-grade gastric MALT lymphoma with diffuse nodularity in a 54-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph shows numerous nodules of varying size in the gastric body and antrum. (b) Photograph of the resected specimen shows diffuse nodules with distinct margins and variable sizes. (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows diffuse tumor cells and lymphoepithelial lesions (arrows) formed by invasion of individual glands by low-grade lymphoma cells.
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Figure 7b. Low-grade gastric MALT lymphoma with diffuse nodularity in a 54-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph shows numerous nodules of varying size in the gastric body and antrum. (b) Photograph of the resected specimen shows diffuse nodules with distinct margins and variable sizes. (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows diffuse tumor cells and lymphoepithelial lesions (arrows) formed by invasion of individual glands by low-grade lymphoma cells.
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Figure 7c. Low-grade gastric MALT lymphoma with diffuse nodularity in a 54-year-old woman. The probable diagnosis was lymphoma. (a) Spot radiograph shows numerous nodules of varying size in the gastric body and antrum. (b) Photograph of the resected specimen shows diffuse nodules with distinct margins and variable sizes. (c) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows diffuse tumor cells and lymphoepithelial lesions (arrows) formed by invasion of individual glands by low-grade lymphoma cells.
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Figure 8a. Low-grade gastric MALT lymphoma with enlarged areae gastricae and subsequent diffuse mucosal nodularity in a 48-year-old man. The probable diagnosis was gastritis. (a) Spot radiograph shows diffuse prominent areae gastricae in the gastric body and antrum. (b) Photograph from endoscopy shows diffuse enlarged areae gastricae. (c) Photograph of the resected specimen shows distinct nodularity of the gastric mucosa. (Fig 8c reprinted, with permission, from reference 20.)
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Figure 8b. Low-grade gastric MALT lymphoma with enlarged areae gastricae and subsequent diffuse mucosal nodularity in a 48-year-old man. The probable diagnosis was gastritis. (a) Spot radiograph shows diffuse prominent areae gastricae in the gastric body and antrum. (b) Photograph from endoscopy shows diffuse enlarged areae gastricae. (c) Photograph of the resected specimen shows distinct nodularity of the gastric mucosa. (Fig 8c reprinted, with permission, from reference 20.)
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Figure 8c. Low-grade gastric MALT lymphoma with enlarged areae gastricae and subsequent diffuse mucosal nodularity in a 48-year-old man. The probable diagnosis was gastritis. (a) Spot radiograph shows diffuse prominent areae gastricae in the gastric body and antrum. (b) Photograph from endoscopy shows diffuse enlarged areae gastricae. (c) Photograph of the resected specimen shows distinct nodularity of the gastric mucosa. (Fig 8c reprinted, with permission, from reference 20.)
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Copyright © 2001 by the Radiological Society of North America.
