Helicobacter pylori-positive colorectal MALT lymphoma with repeated metachronous recurrence after a complete response to eradication therapy and regression after a watch-and-wait strategy.

in Internal medicine (Tokyo, Japan) by Daisuke Shimizu, Hidehiko Takigawa, Yuki Kitadai, Misa Ariyoshi, Ryo Miyamoto, Yuichi Hiyama, Yuji Urabe, Akira Ishikawa, Toshio Kuwai, Shiro Oka

TLDR

  • A 77-year-old man was diagnosed with localized colorectal MALT lymphoma and treated with eradication therapy, which was successful and regressed the lesion. However, new lesions recurred and were managed with a watch-and-wait strategy without additional treatment.
  • Key Insights: The patient's lesions regressed after eradication therapy and again without treatment, highlighting the potential effectiveness of a watch-and-wait strategy for colorectal MALT lymphoma recurrences.

Abstract

A 77-year-old man underwent a colonoscopy. A submucosal cecal tumor was found, and localized colorectal MALT lymphoma (Lugano stage I) was diagnosed with a Helicobacter pylori infection. The first-line eradication therapy was successful, and the cecal lesion regressed. However, a new lesion was observed in the lower rectum. The rectal lesion regressed after the second-line eradication therapy. Two new lesions were identified in the sigmoid colon. However, no additional treatment was administered and a watch-and-wait strategy was adopted. Both of the lesions regressed. There are no established treatments for colorectal MALT lymphomas. The watch-and-wait strategy may be effective in cases of recurrence after eradication therapy.

Overview

  • A 77-year-old man underwent a colonoscopy that revealed a submucosal cecal tumor, which was diagnosed as localized colorectal MALT lymphoma (Lugano stage I) with a Helicobacter pylori infection.
  • The patient underwent first-line eradication therapy, which was successful and caused the cecal lesion to regress.
  • However, new lesions were observed in the lower rectum and sigmoid colon, and a watch-and-wait strategy was adopted without additional treatment.

Comparative Analysis & Findings

  • The patient's lesions regressed after first-line eradication therapy, but recurred in the rectum and sigmoid colon.
  • The watch-and-wait strategy was effective in treating the new lesions, which regressed without additional treatment.
  • There are no established treatments for colorectal MALT lymphomas, making the watch-and-wait strategy a viable option for this patient.

Implications and Future Directions

  • The watch-and-wait strategy may be a useful approach for treating colorectal MALT lymphoma recurrences after eradication therapy.
  • Further research is needed to establish effective treatment options for colorectal MALT lymphomas.
  • The use of eradication therapy and monitoring may be a viable approach for managing patients with small lesions that do not require immediate treatment.
Read Full Article