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LETTER TO EDITOR  
Year : 2014  |  Volume : 57  |  Issue : 3  |  Page : 502-503
Mucosa associated lymphoid tissue lymphoma of gallbladder: A rare presentation


1 Department of Pathology, Advanced Medicare and Research Institute (Vision Care Hospital), Mukundapur, Kalikapur, India
2 Department of Pathology, Advanced Medicare and Research Institute, AMRI Hospitals Salt Lake, Salt Lake City, Kolkata, West Bengal, India

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Date of Web Publication14-Aug-2014
 

How to cite this article:
Mitra S, Mukherjee S, Chakraborty H. Mucosa associated lymphoid tissue lymphoma of gallbladder: A rare presentation. Indian J Pathol Microbiol 2014;57:502-3

How to cite this URL:
Mitra S, Mukherjee S, Chakraborty H. Mucosa associated lymphoid tissue lymphoma of gallbladder: A rare presentation. Indian J Pathol Microbiol [serial online] 2014 [cited 2021 Nov 28];57:502-3. Available from: https://www.ijpmonline.org/text.asp?2014/57/3/502/138804


Editor,

Primary lymphomas of mucosa associated lymphoid tissue (MALT) within the gallbladder are very rare and usually present with symptoms mimicking cholecystitis. [1]

A 73-year-old male presented at the hospital with complaints of abdominal pain and distension. On examination, there was tenderness in the right hypochondrium, and after an ultrasonographic examination, a diagnosis of acute cholecystitis with cholelithiasis and thickened gall bladder wall was given.

The patient underwent laparoscopic cholecystectomy, and an inflamed gall bladder along with multiple small faceted stones was removed. On grossing, the gall bladder had a moderately thickened wall and representative sections were taken from neck, body, fundus, and cystic node.

Microscopic examination revealed diffuse infiltration of gall bladder wall including mucosa and submucosa, by small to medium sized lymphoid cells with monocytoid appearance, admixed with plasma cells. Few ill-defined follicles were seen. Cystic node showed loss of architecture and diffuse infiltration by neoplastic lymphoid cells [Figure 1].
Figure 1: (a and b) Infiltration of small to medium sized centrocyte-like cells in the gall bladder extending into the submucosa (H and E, ×100)

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Immunohistochemical staining was done and infiltrating lymphoid cells in the gall bladder and cystic lymph node were found to express CD20 and Bcl-2, while being immunonegative for CD3, CD5, CD10, CD23 and cyclin D1 [Figure 2]. A final histological diagnosis of MALT type lymphoma of gall bladder, with marginal zone B-cell lymphoma in cystic lymph node, was given. No dissemination of lymphoma was detected. Cholecystectomy without adjuvant chemotherapy is the appropriate treatment of choice. The patient remained disease-free during 1-year of follow-up.
Figure 2: (a) Neoplastic cells in gall bladder positive for CD20 (immunoperoxidase, ×100), (b) neoplastic cells in gall bladder positive for Bcl-2 (immunoperoxidase, ×100), (c) neoplastic cells in lymph node
positive for CD20 (immunoperoxidase, ×100), (d) neoplastic cells in lymph node positive for Bcl-2 (immunoperoxidase, ×100)


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Extra-nodal lymphomas often involve Waldeyer's ring or the gastrointestinal tract, but are very rare in the gall bladder, as it is normally devoid of lymphoid tissue. Only 0.1-0.2% of malignancies arising in the gall bladder are lymphomas; the most common being diffuse large B-cell lymphomas and primary MALT lymphomas. [1],[2],[3] Only eight cases of the latter have been reported until date, in the English literature. [3],[4]

Lymphomas of the gall bladder are thought to be related with chronic inflammation or bacterial infection, leading to secondary follicle formation. Continuous antigenic stimulation may cause chromosomal translocations resulting in apoptosis-inhibiting fusion protein and subsequent neoplastic progression. [3]

Mucosa associated lymphoid tissue lymphomas usually cause homogeneous thickening of the gall bladder wall, unlike high-grade lymphomas, which tend to form solid masses. [2] The typical histological pattern of MALT lymphoma/extra-nodal marginal zone lymphoma is of small cleaved cells (centrocyte-like), along with small lymphoid cells and plasma cells. [5] Unlike other primary non-Hodgkin lymphomas of gall bladder, which have a poor prognosis, MALT lymphomas have an excellent prognosis, and cholecystectomy alone is considered curative. [3]

Mucosa associated lymphoid tissue lymphomas tend to remain localized and recurrences are rare.

 
   References Top

1.
Mani H, Climent F, Colomo L, Pittaluga S, Raffeld M, Jaffe ES. Gall bladder and extrahepatic bile duct lymphomas: Clinicopathological observations and biological implications. Am J Surg Pathol 2010;34:1277-86.  Back to cited text no. 1
    
2.
Ono A, Tanoue S, Yamada Y, Takaji Y, Okada F, Matsumoto S, et al. Primary malignant lymphoma of the gallbladder: A case report and literature review. Br J Radiol 2009;82:e15-9.  Back to cited text no. 2
    
3.
Koshy M, Zhao F, Garofalo MC. Primary MALT lymphoma of the gallbladder. Case report. J Gastrointestin Liver Dis 2008;17:207-10.  Back to cited text no. 3
    
4.
Bagwan IN, Ping B, Lavender L, de Sanctis S. Incidental presentation of gall bladder MALT lymphoma. J Gastrointest Cancer 2011;42:61-4.  Back to cited text no. 4
    
5.
Isaacson P, Wright DH. Malignant lymphoma of mucosa-associated lymphoid tissue. A distinctive type of B-cell lymphoma. Cancer 1983;52:1410-6.  Back to cited text no. 5
    

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Correspondence Address:
Subhashis Mitra
Department of Pathology, Advanced Medicare and Research Institute (Vision Care Hospital), 223, 230 Barkohala Lane, Mukundapur, Kalikapur, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.138804

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