Originally published as JCO Early Release 10.1200/JCO.2006.06.0723 on June 12 2006

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Assessment of Disease Dissemination in Gastric Compared With Extragastric Mucosa-Associated Lymphoid Tissue Lymphoma Using Extensive Staging: A Single-Center Experience

Markus Raderer, Stefan Wöhrer, Berthold Streubel, Marlene Troch, Karl Turetschek, Ulrich Jäger, Cathrin Skrabs, Alexander Gaiger, Johannes Drach, Andreas Puespoek, Michael Formanek, Martha Hoffmann, Wolfgang Hauff, Andreas Chott

From the Departments of Internal Medicine I and IV, Pathology, Radiology, Otorhinolaryngology, Ophthalmology, and Nuclear Medicine, University of Vienna; and the Center of Excellence in Clinical and Experimental Oncology, Vienna, Austria

Address reprint requests to Markus Raderer, MD, Department of Internal Medicine I, Division of Oncology, Waehringer Guertel 18-20, A-1090 Vienna, Austria; e-mail: markus.raderer{at}meduniwien.ac.at

PURPOSE: Molecular data and preliminary clinical findings have suggested mucosa-associated lymphoid tissue (MALT) lymphoma as a multifocal disease in a high percentage of patients. We report our findings with an extensive staging routine applied in patients diagnosed with MALT lymphoma at our institution.

PATIENTS AND METHODS: A total of 140 consecutive patients (61 with gastric and 79 with extragastric MALT lymphoma) underwent staging according to a standardized protocol. Staging included gastroscopy with multiple biopsies, endosonography of the upper GI tract, computed tomography of thorax and abdomen, lymph node sonography, colonoscopy with multiple biopsies, otorhinolaryngologic assessment, magnetic resonance imaging of salivary and lacrimal glands, and bone marrow biopsy. All lesions suggestive of lymphoma involvement were subjected to biopsy, if accessible, and biopsies were evaluated for MALT lymphoma–specific genetic aberrations by means of reverse transcriptase polymerase chain reaction and/or fluorescent in situ hybridization.

RESULTS: Fifteen (25%) of 61 patients with gastric MALT lymphoma had multiorgan involvement, with dissemination beyond the GI tract in six patients. By contrast, significantly more patients with extragastric MALT lymphoma had dissemination to another MALT organ (37 of 79 patients, 46%; P = .045). Nine of these 37 patients had dissemination to the stomach. Only three (2%) of 140 patients had bone marrow involvement. Multifocality was significantly associated with t(11;18)(q21;q21) in gastric lymphomas (P = .045) and with trisomy 18 in extragastric lymphomas (P = .011).

CONCLUSION: Our findings suggest that MALT lymphoma frequently presents as a multifocal disease. Extragastric MALT lymphomas are significantly more prone to dissemination than gastric MALT lymphomas.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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