Simultaneous primary low-grade mucosa-associated lymphoid tissue lymphoma of stomach and duodenum.

ried out in a local hospital revealed expansion both within and outside the liver bile duct but found no stone or neoplasm. Then, she was referred to our hospital where physical examination revealed epigastric tenderness while the liver, spleen, and superficial lymph nodes were not palpable. The patient’s main laboratory data showed no abnormality except for a slight elevation of tumor markers CA199 and CA242. The chest X-ray, computed tomography scan of the abdomen and peripheral blood were normal. On the basis of the above investigations, we planned to perform an ERCP (endoscopic retrograde cholangiopancreatography) to confirm the diagnosis. To our surprise, we observed large hypertrophied rugal folds as well as multiple mucosal ulcerations in both stomach and duodenum ( fig. 1 a, c). While waiting for the biopsies to be reviewed, a barium examination of the gastrointestinal tract revealed enlarged mucosa folds throughout the whole stomach and a diffuse spread of disease in the whole duodenum ( fig. 2 ). Histologic sections of the biopsies showed mucosal interstitial cells with large stained nucleus ( fig. 3 a). 14 Curea breath test showed Helicobacter pylori infection. Repeat multiple deeper biopsies were taken and revealed histopathologic findings consistent with the diagnosis of low-grade MALT lymphoma. Immunohistochemical stains demonstrated the lymphocytes to be CD20, LCA-positive and Dear Sir, With the introduction of the entity MALT (mucosa-associated lymphoid tissue) lymphoma by Isaacson and Wright, more and more MALT lymphomas have been diagnosed. Most MALT lymphomas arise from gastrointestinal organs as well as from extragastrointestinal organs such as the salivary gland, thyroid gland, lung, bladder, and skin. In the majority of the studies, the stomach is the most common site involved, accounting for more than 75% of gastrointestinal tract lymphomas [1] , while simultaneous MALT lymphoma of stomach and duodenum is very rare. To our knowledge, very few cases of primary gastrointestinal lymphoma that involve both stomach and duodenum are reported in the literature. We report here a very rare case with MALT lymphoma arising in both stomach and duodenum and review the literature.