SHM Converge Scientific Abstract ePoster Gallery-The Perfect Image of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

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This case highlights the diagnostic challenge of gastric MALT lymphoma when initial biopsies are negative despite highly suspicious imaging and endoscopic findings. A 60-year-old man with a history of prostate cancer and Parkinson’s disease presented with one day of right-sided abdominal pain, nausea, and vertigo. CT abdomen/pelvis with contrast revealed extensive nodular thickening of the gastric wall, especially in the fundus, mild pyloric stricturing, numerous small perigastric lymph nodes, and liver masses.  <br /><br />Endoscopy showed malignant-appearing gastric tumors in the fundus, incisura, and antrum, but the initial biopsy demonstrated only chronic inflammation, fibrosis, and reactive changes, with no evidence of H. pylori, dysplasia, or malignancy. Because gastric MALT lymphoma often arises from deep mucosa or submucosa and can have variable, nonspecific endoscopic appearances, false-negative biopsies may occur.  <br /><br />Five weeks later, repeat EGD with EUS showed progression, including growth and bleeding of several gastric masses. Repeat biopsy confirmed gastric MALT lymphoma, again negative for H. pylori.  <br /><br />The case emphasizes that when CT and endoscopic findings strongly suggest gastric MALT lymphoma or malignancy, clinicians should not rely on a single negative biopsy. Obtaining multiple biopsies and considering deeper sampling techniques, such as endoscopic mucosal resection or submucosal dissection, may reduce delays in diagnosis and treatment.

Asset Subtitle

Rodrigo Paredes

Meta Tag

Author List Bharati Dev, Ernst Kristina, Liliana Vittini MD, Rodrigo Paredes

Category Clinical Vignettes

Concept Gastric MALT Lymphoma

Concept Endoscopic Findings

Concept Gastric Biopsy

Concept Helicobacter pylori Infection

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai, Department of Medicine Mount Sinai Morningside/West

Presenting Author Rodrigo Paredes

Track Adult

Keywords

gastric MALT lymphoma

negative biopsy

endoscopy

CT imaging

perigastric lymph nodes

gastric wall thickening

EUS

repeat biopsy

H. pylori negative

submucosal sampling

Gastric MALT Lymphoma

Endoscopic Findings

Gastric Biopsy

Helicobacter pylori Infection

Clinical Presentation