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Regression of Mucosa-Associated Lymphoid Tissue Lymphoma of the Bladder After Antibiotic Therapy

Royal Bournemouth Hospital, Bournemouth, United Kingdom
Southampton University Hospital, Southampton, United Kingdom

To the Editor:Extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas) frequently arise in the context of autoimmune disease or chronic bacterial infection.^1,2 The resolution of early gastric MALT lymphoma after eradication of Helicobacter pylori infection is well documented. We report a case of primary MALT lymphoma of the bladder that resolved macroscopically after antibiotic treatment of chronic urinary tract infection.

A 78-year-old woman was referred for investigation of recurrent Escherichia coli urinary tract infections. At cystoscopy, an unusual mucosal cobblestone appearance, 4-cm in diameter, was seen on the left lateral wall of the bladder. The biopsy consisted of multiple fragments, one of which showed extensive cystitis cystica. All fragments showed a dense subepithelial infiltrate of lymphoid cells that did not extend to the underlying muscularis. In some fragments, the lymphoid infiltrate contained reactive germinal centers, in others it was composed of a monomorphic population of marginal-zone cells with oval nuclei and clear cytoplasm. There were scattered small aggregates of plasma cells, mainly in a subepithelial location. These did not show light chain restriction in immunohistochemical preparations. Small clusters of marginal-zone cells within the overlying urothelium had the appearance of lymphoepithelial lesions. These were highlighted by immunohistochemical staining for B-lineage markers (CD20 and CD79a) and were outlined by stains for cytokeratins. The appearances were interpreted as being those of an extranodal marginal-zone lymphoma of the urinary bladder. Polymerase chain reaction analysis of DNA extracted from paraffin-embedded tissue showed an immunoglobulin H (FR2) rearrangement consistent with a clonal B-cell disorder. A computed tomography scan of the chest, abdomen, and pelvis showed no abnormality, and morphologic examination of blood, bone marrow aspirate, and trephine was normal. The patient received continuous antibiotic therapy (monthly cycles of trimethoprim, nitrofurantoin, and cephradine) with resolution of the bacteruria, and repeat cystoscopies at 7 and 19 months were macroscopically normal.

MALT lymphoma is the most common variety of primary bladder lymphoma. The disease is more common in women, and there is frequently a history of chronic cystitis. Dissemination to other MALT sites is a late event, and the prognosis is excellent.^3-5

Our experience would suggest that antibiotic therapy would be a reasonable initial therapeutic option in a patient with a localized MALT lymphoma of the bladder that is associated with histologic or microbiologic evidence of urinary tract infection.

REFERENCES

1. Zucca E, Bertoni F, Roggero E, et al: The gastric marginal zone B-cell lymphoma of MALT type. Blood 96: 410, 2000[Free Full Text]

2. Cerroni L, Zochling N, Putz B, et al: Infection by Borrelia burgdorferi and cutaneous B-cell lymphoma. J Cutan Pathol 8: 457-461, 1997

3. Ohsawa M, Aozasa K, Horiuchi K, et al: Malignant lymphoma of bladder. Cancer 72: 1969-1974, 1993[Medline]

4. Kempton CL, Kurtin PJ, Inwards DJ, et al: Malignant lymphoma of the bladder: Evidence from 36 cases that low-grade lymphoma of the MALT type is the most common primary bladder lymphoma. Am J Surg Pathol 21: 1324-1333, 1997[CrossRef][Medline]

5. Bates AW, Norton AJ, Baithun SI: Malignant lymphoma of the urinary bladder: A clinicopathological study of 11 cases. J Clin Pathol 53: 458-461, 2000[Abstract/Free Full Text]

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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oscier, D. Articles by Wright, D. Search for Related Content PubMed PubMed Citation Articles by Oscier, D. Articles by Wright, D. Social Bookmarking                            What's this?