DDSEP® 8 Quick Quiz

April 2017 Quiz 2

Publish date: April 1, 2017

Q2. A 56-year-old woman presents with epigastric pain and is found to have a 3-cm submucosal mass with thickened rugal folds in the gastric body. Biopsies of the mass show mucosa-associated lymphoid tissue (MALT lymphoma). There is no evidence of Helicobacter pylori infection in the biopsies.

What is the best next step in this patient’s care?

Refer to oncology for chemotherapy

Upper GI radiographic study

Perform H. pylori breath test

Measure gastric pH

Refer for surgical resection

Q2. Answer: C

Rationale: MALT lymphomas are associated with H. pylori infection in 80%-90% of cases. H. pylori triggers a B-cell clonal expansion leading to lymphoma. Detection of chronic H. pylori using histology is directly dependent on the number of mucosal biopsies. Negative H. pylori testing should prompt an alternative test for H. pylori (either breath or stool antigen test). Treatment of H. pylori is successful in achieving complete remission in up to 80% of cases. Surveillance after treatment of MALT lymphoma is indicated, though the exact protocol has not been established.

References

1. ASGE Standards of Practice Committee. The role of endoscopy in management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015 82(1):1-8.

2. Gisbert J.P., Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther. 2011 Nov;34(9):1047-62.

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April 2017 Quiz 1