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Intestinal dissemination of gastric mucosa-associated lymphoid tissue
lymphoma
MQ Du, CF Xu, TC Diss, HZ Peng, AC Wotherspoon, PG Isaacson and LX Pan
Department of Histopathology, University College London Medical School, UK.
Despite increasing identification of concurrent gastric and intestinal
lymphomas of mucosa-associated lymphoid tissue (MALT), the clonal
relationship between the two tumors and their sequential development are
poorly understood. It is also unknown whether the development of these
concurrent tumors is closely associated with direct antigen stimulation,
which is thought to play an important role in the clonal expansion of
low-grade MALT lymphomas. To investigate these, we have studied six cases
of concurrent gastric and intestinal MALT lymphomas by polymerase chain
reaction (PCR) amplification, cloning, and sequencing of the rearranged Ig
gene, a strategy that has been widely used for analysis of clonality and
antigen-driven properties of B-cell malignancies. In each case, an
identical or nearly identical complementarity determining region (CDR) 3
sequence was observed between the dominant clones of concurrent gastric and
intestinal MALT lymphomas. In four of six cases examined, sufficient Ig
variable region sequence information was obtained to permit analysis of
somatic mutations. The mutation patterns in one case suggest that the
intestinal lesion is secondary to the gastric tumor, and the mutation
patterns in two cases indicate that the gastric and intestinal lesions are
derived from different tumour subclones, which emerge after expansion of a
common early tumor clone. Furthermore, three of four cases showed ongoing
Ig mutations among different PCR clones at each site. These results show
that concurrent gastric and intestinal MALT lymphomas are derived from the
same clone and suggest that the intestinal lesions result from
dissemination of gastric tumours. Antigen stimulation may play a role in
tumor evolution, particularly at an early stage.
Volume 88,
Issue 12,
pp. 4445-4451,
12/15/1996
Copyright © 1996 by The American Society of Hematology
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