A 55-year-old man presents with recurrent epigastric pain. Upper GI endoscopy and gastric biopsy reveal a neoplastic, lymphocytic infiltrate invading glandular tissue. Giemsa staining is positive for Helicobacter pylori. Which of the following is the most likely diagnosis?
**Core Concept**
Helicobacter pylori infection is associated with the development of gastric mucosa-associated lymphoid tissue (MALT) lymphoma, also known as marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma). This type of lymphoma arises in the context of chronic inflammation and immune response to the bacterial infection.
**Why the Correct Answer is Right**
Marginal zone lymphoma is characterized by the presence of neoplastic lymphocytes, often with a marginal zone phenotype, infiltrating the gastric mucosa. The lymphocytic infiltrate in the gastric biopsy is consistent with this diagnosis. The positive Giemsa staining for Helicobacter pylori further supports the association of this infection with the development of MALT lymphoma. The lymphoma cells often express B-cell markers and may exhibit a variety of morphological features, including centrocyte-like cells and monocytoid B cells.
**Why Each Wrong Option is Incorrect**
* **Option A:** Burkitt lymphoma is a high-grade B-cell lymphoma that typically presents in the jaw or abdomen, often with a more aggressive clinical course. It is not typically associated with Helicobacter pylori infection.
* **Option C:** Follicular lymphoma is a type of B-cell lymphoma characterized by the presence of follicular dendritic cells and a specific pattern of B-cell proliferation. It is not typically associated with Helicobacter pylori infection.
* **Option D:** Mantle cell lymphoma is a type of B-cell lymphoma that often presents with a more aggressive clinical course and is characterized by the overexpression of cyclin D1. It is not typically associated with Helicobacter pylori infection.
**Clinical Pearl / High-Yield Fact**
The diagnosis of MALT lymphoma can be challenging, but the presence of Helicobacter pylori infection and a lymphocytic infiltrate in the gastric biopsy can provide important clues. Treatment of the underlying Helicobacter pylori infection can lead to regression of the lymphoma in some cases, highlighting the importance of considering the role of chronic inflammation in the development of lymphoid neoplasms.
✓ Correct Answer: B. Marginal zone lymphoma