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Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies.
Am J Surg Pathol 2005; 29(12):1582-92AJ

Abstract

The evolution of low-grade B-cell mucosa-associated lymphoid-tissue (MALT) lymphoma of the stomach is a multistage process, reflected in the histologic continuum from Helicobacter pylori-chronic gastritis, to low-grade and high-grade lymphoma. Interestingly, in daily gastric biopsy sign-out, the authors observed that some biopsies showed monoclonality on polymerase chain reaction (PCR) even though there were no definite histologic features of malignancy and vice versa. To address the question, the authors studied the endoscopic gastric biopsies at first presentation of 46 patients to examine any clonality differences among various histologic patterns within the spectrum of MALT lymphoma evolution. The gastric biopsies were reviewed histologically and graded according to the Wotherspoon-Isaacson histologic scoring system from grade 0 (normal) to grade 5 (MALT lymphoma). The clonality of cases in each grade was determined by performing nested PCR for immunoglobulin heavy chain (IgH) gene rearrangement using FR2/JH and FR3/JH primer sets. The monoclonality rates among different grades were as follows: grade 2, 6.3% (1 of 16); grade 3, 27.3% (3 of 11); grade 4, 83.3% (5 of 6); grade 5, 69.2% (9 of 13). Statistically significant difference of monoclonality rate is demonstrated in histologic grade 4 versus grades 2 and 3, and grade 5 versus grade 2 (P < 0.05, Fisher exact test). The authors went on to examine the progress of disease by following up the clinical status, histologic changes, and clonality fluctuation of these cases. Four of the 8 patients with monoclonality on PCR, but no definite lymphoma at first presentation later progressed to frank MALT lymphoma. Our study shows that, during the progression to MALT lymphoma, there is an instability of clonality. Clonality can fluctuate between polyclonality, oligoclonality, and monoclonality, none of which defines an irreversible stage for progression to MALT lymphoma. Monoclonality is a risk factor for development of MALT lymphoma. Those cases with dense gastric mucosal lymphoid infiltrate (without definite MALT lymphoma) and monoclonality on PCR need to be closely monitored and Helicobacter infection promptly treated if present. In combination with clinicohistologic examination, PCR can serve as a complementary tool in arriving at a definite diagnosis of MALT lymphoma in cases with borderline histologic features.

Authors+Show Affiliations

Pathology Service, Caritas Medical Centre, Kowloon, Hong Kong, China. williamyflo@yahoo.com.hk

Pub Type(s)

Case Reports
Comparative Study
Journal Article

Language

eng

PubMed ID

16327430

Citation

Lo, William Y F., et al. "Instability of Clonality in Gastric Lymphoid Infiltrates: a Study With Emphasis On Serial Biopsies." The American Journal of Surgical Pathology, vol. 29, no. 12, 2005, pp. 1582-92.
Lo WY, Li JY, Chan YK, et al. Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies. Am J Surg Pathol. 2005;29(12):1582-92.
Lo, W. Y., Li, J. Y., Chan, Y. K., Lai, L. S., Yeung, Y. W., Lo, S. T., ... Ng, C. S. (2005). Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies. The American Journal of Surgical Pathology, 29(12), pp. 1582-92.
Lo WY, et al. Instability of Clonality in Gastric Lymphoid Infiltrates: a Study With Emphasis On Serial Biopsies. Am J Surg Pathol. 2005;29(12):1582-92. PubMed PMID: 16327430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies. AU - Lo,William Y F, AU - Li,Jackson Y W, AU - Chan,Y K, AU - Lai,Lawrence S W, AU - Yeung,Y W, AU - Lo,Stephen T H, AU - Tsui,Wilson M S, AU - Ng,C S, PY - 2005/12/6/pubmed PY - 2006/1/18/medline PY - 2005/12/6/entrez SP - 1582 EP - 92 JF - The American journal of surgical pathology JO - Am. J. Surg. Pathol. VL - 29 IS - 12 N2 - The evolution of low-grade B-cell mucosa-associated lymphoid-tissue (MALT) lymphoma of the stomach is a multistage process, reflected in the histologic continuum from Helicobacter pylori-chronic gastritis, to low-grade and high-grade lymphoma. Interestingly, in daily gastric biopsy sign-out, the authors observed that some biopsies showed monoclonality on polymerase chain reaction (PCR) even though there were no definite histologic features of malignancy and vice versa. To address the question, the authors studied the endoscopic gastric biopsies at first presentation of 46 patients to examine any clonality differences among various histologic patterns within the spectrum of MALT lymphoma evolution. The gastric biopsies were reviewed histologically and graded according to the Wotherspoon-Isaacson histologic scoring system from grade 0 (normal) to grade 5 (MALT lymphoma). The clonality of cases in each grade was determined by performing nested PCR for immunoglobulin heavy chain (IgH) gene rearrangement using FR2/JH and FR3/JH primer sets. The monoclonality rates among different grades were as follows: grade 2, 6.3% (1 of 16); grade 3, 27.3% (3 of 11); grade 4, 83.3% (5 of 6); grade 5, 69.2% (9 of 13). Statistically significant difference of monoclonality rate is demonstrated in histologic grade 4 versus grades 2 and 3, and grade 5 versus grade 2 (P < 0.05, Fisher exact test). The authors went on to examine the progress of disease by following up the clinical status, histologic changes, and clonality fluctuation of these cases. Four of the 8 patients with monoclonality on PCR, but no definite lymphoma at first presentation later progressed to frank MALT lymphoma. Our study shows that, during the progression to MALT lymphoma, there is an instability of clonality. Clonality can fluctuate between polyclonality, oligoclonality, and monoclonality, none of which defines an irreversible stage for progression to MALT lymphoma. Monoclonality is a risk factor for development of MALT lymphoma. Those cases with dense gastric mucosal lymphoid infiltrate (without definite MALT lymphoma) and monoclonality on PCR need to be closely monitored and Helicobacter infection promptly treated if present. In combination with clinicohistologic examination, PCR can serve as a complementary tool in arriving at a definite diagnosis of MALT lymphoma in cases with borderline histologic features. SN - 0147-5185 UR - https://www.unboundmedicine.com/medline/citation/16327430/Instability_of_clonality_in_gastric_lymphoid_infiltrates:_a_study_with_emphasis_on_serial_biopsies_ L2 - http://Insights.ovid.com/pubmed?pmid=16327430 DB - PRIME DP - Unbound Medicine ER -