HP34P
EXTRANODAL MARGINAL ZONE B‐CELL LYMPHOMA OF MUCOSA ASSOCIATED LYMPHOID TISSUE (MALT) TYPE OF THE GALLBLADDER

• Published in: ANZ journal of surgery Vol. 77; no. s1; p. A47
• Main Authors: Ng, S. K., Epair, K., Parsons, S., Wei, A., Banting, S. W.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-05-2007
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2007.04122_34.x

Purpose  Extranodal marginal zone B‐cell lymphoma of mucosa associated lymphoid tissue (MALT) type of the gallbladder is rare. We described a case of MALT lymphoma of the gallbladder with splenic and pulmonary dissemination, followed by a review of similar cases reported in English literature.
Background  A 60 year old woman presented to our surgical unit with abnormal liver function tests and gallbladder thickening on ultrasonography. Cholecystectomy revealed a chronically inflamed gallbladder with multiple gallstones. Histology showed abnormal sheets of small B lymphoid cells which were CD 20 positive, consistent with a diagnosis of MALT lymphoma. Staging CT showed bilateral pulmonary nodules and mild splenomegaly. PET scan demonstrated increase uptake in lung fields and normal uptake in spleen, bone marrow and lymph node. Bone marrow examination was negative. Final diagnosis is Stage 4 extranodal MALT. She remained in remission on three‐month review. No additional chemotherapy or radiotherapy was administered.
Discussion  Extranodal MALT lymphoma of the gallbladder has similar epidemiological features with other extranodal MALT lymphomas. Most patients present with symptoms consistent with cholecystitis. As the gallbladder does not normally contain lymphocytes, persistent lymphoid proliferation due to chronic inflammation may represent a critical step in the development and progression of MALT lymphoma (1). Cholecystectomy without adjuvant therapy is appropriate first line treatment if there is no other symptomatic disease (2). Long term surveillance for relapse and second lymphoma should be considered.