eMedicine Specialties > Hematology > Stem Cells and Disorders

Mucosa-Associated Lymphoid Tissue: Follow-up

Author: Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Coauthor(s): Jose A Perez Jr, MD, MSEd, MBA, Consulting Physician, Department of Internal Medicine, Residency Director, Vice Chair of Education Department of Medicine, The Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College
Contributor Information and Disclosures

Updated: Oct 14, 2008

Follow-up

Further Outpatient Care

  • Patients with MALToma should continue to receive serial examinations at increasing frequencies for several years following the successful completion of therapy.

Prognosis

  • Generally, low-grade MALTomas are indolent neoplasms with a fairly good prognosis.
  • MALTomas that are not eradicated by treatment of H. pylori infection are incurable but are associated with a long course.
  • Although the intermediate-grade, diffuse, large B-cell MALTomas are more aggressive malignancies, the cure rate may be as high as 90% for stage IE disease and is approximately 30-40% for extensive stage IIIE or IVE disease. These outcomes are similar to non-MALT intermediate-grade NHLs.
  • Gastric MALTomas have a stage-dependent prognosis. The survival rate for stage IE disease is 93% at 5 years and 58% at 10 years.20 Long-term responses to anti– H. pylori treatment alone have been reported.
  • Nongastrointestinal MALTomas are most common in the head and neck, ocular adnexa, and lungs.
  • Several small studies have reported that observation alone may be appropriate in selected patients with ocular adnexal MALToma.
    • The prognosis depends on the grade of the tumor, with long-term survival possible for patients with low-grade tumors. However, achieving a cure is more difficult in patients with MALTomas in advanced stages.
    • Use of the International Prognostic Index — taking into account age, Ann Arbor stage, lactate dehydrogenase (LDH) levels, the number of extranodal sites, and performance status — has better characterized low-, intermediate-, and high-risk groups. Five-year survival rates in these groups are 99% for the low-risk groups; 85-88%, intermediate-risk groups; and 72%, for high-risk groups. Patients with early-stage MALToma may be curable with chemotherapy.
    • The risks and benefits of surgical or radiation therapy for MALTomas should be considered before proceeding.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose cancer is one of the most frequent reasons for medical malpractice actions. Suggestive symptoms should be thoroughly investigated.
  • Failure to diagnose the correct subtype of lymphoma and subsequent use of treatment for another type of lymphoma or other malignancy that is not optimal therapy for MALToma is a medicolegal hazard.
  • Inappropriately aggressive surgical, radiation, or medical therapy that results in serious injury or long-term disability is a potentially serious medicolegal hazard in the management of MALTomas.
 


More on Mucosa-Associated Lymphoid Tissue

Overview: Mucosa-Associated Lymphoid Tissue
Differential Diagnoses & Workup: Mucosa-Associated Lymphoid Tissue
Treatment & Medication: Mucosa-Associated Lymphoid Tissue
Follow-up: Mucosa-Associated Lymphoid Tissue
References

References

  1. Johnson RM, Brown EJ. Cell-mediated immunity in host defense against infectious diseases. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:131-4.

  2. Greer JP, Macon WR, McCurley TL. Non-Hodgkin lymphoma. In: Lee GR, Foerster J, Lukens J, et al, eds. Wintrobe's Clinical Hematology. 10th ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1999:2471-3.

  3. Bufo P. The MALTomas. Academic lesson; 1999.

  4. Santacroce L. Anatomy, physiology and surgical pathophysiology of the MALT. Academic lesson; 1997.

  5. Beagley KW, Elson CO. Cells and cytokines in mucosal immunity and inflammation. Gastroenterol Clin North Am. Jun 1992;21(2):347-66. [Medline].

  6. Featherstone C. M cells: portals to the mucosal immune system. Lancet. Oct 25 1997;350(9086):1230. [Medline].

  7. Hamzaoui N, Pringault E. Interaction of microorganisms, epithelium, and lymphoid cells of the mucosa-associated lymphoid tissue. Ann N Y Acad Sci. Nov 17 1998;859:65-74. [Medline].

  8. Dubois B, Barthélémy C, Durand I, et al. Toward a role of dendritic cells in the germinal center reaction: triggering of B cell proliferation and isotype switching. J Immunol. Mar 15 1999;162(6):3428-36. [Medline][Full Text].

  9. Delves PJ, Roitt IM. The immune system. First of two parts. N Engl J Med. Jul 6 2000;343(1):37-49. [Medline].

  10. Delves PJ, Roitt IM. The immune system. Second of two parts. N Engl J Med. Jul 13 2000;343(2):108-17. [Medline].

  11. Chin YH, Cai JP, Hieselaar T. Lymphocyte migration into mucosal lymphoid tissues: mechanism and modulation. Immunol Res. 1991;10(3-4):271-8. [Medline].

  12. Keren DF. Intestinal mucosal immune defense mechanisms. Am J Surg Pathol. 1988;12 suppl 1:100-5. [Medline].

  13. Cavalli F, Isaacson PG, Gascoyne RD, Zucca E. MALT Lymphomas. Hematology Am Soc Hematol Educ Program. 2001;241-58. [Medline][Full Text].

  14. Perry C, Herishanu Y, Metzer U, et al. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Haematol. Sep 2007;79(3):205-9. [Medline].

  15. Chen Y, Inobe J, Marks R, et al. Peripheral deletion of antigen-reactive T cells in oral tolerance. Nature. Jul 13 1995;376(6536):177-80. [Medline].

  16. Bachert C, Möller P. [The tonsils as MALT (mucosa-associated lymphoid tissue) of the nasal mucosa] [German]. Laryngorhinootologie. Oct 1990;69(10):515-20. [Medline].

  17. Kracke A, Hiller AS, Tschernig T, et al. Larynx-associated lymphoid tissue (LALT) in young children. Anat Rec. Jul 1997;248(3):413-20. [Medline].

  18. Lugton I. Mucosa-associated lymphoid tissues as sites for uptake, carriage and excretion of tubercle bacilli and other pathogenic mycobacteria. Immunol Cell Biol. Aug 1999;77(4):364-72. [Medline].

  19. Ferreri AJ, Assanelli A, Crocchiolo R, et al. Therapeutic management of ocular adnexal MALT lymphoma. Expert Opin Pharmacother. Jun 2007;8(8):1073-83. [Medline].

  20. Fung CY, Grossbard ML, Linggood RM, et al. Mucosa-associated lymphoid tissue lymphoma of the stomach: long term outcome after local treatment. Cancer. Jan 1 1999;85(1):9-17. [Medline][Full Text].

  21. Babcock GJ, Thorley-Lawson DA. Tonsillar memory B cells, latently infected with Epstein-Barr virus, express the restricted pattern of latent genes previously found only in Epstein-Barr virus-associated tumors. Proc Natl Acad Sci U S A. Oct 24 2000;97(22):12250-5. [Medline][Full Text].

  22. Brandtzaeg P, Sollid LM, Bjerke K, et al. Interactions of lymphoid cells with the epithelial environment. Monogr Allergy. 1988;24:51-9. [Medline].

  23. Dürkop H, Anagnostopoulos I, Bulfone-Paus S, Stein H. Expression of several members of the TNF-ligand and receptor family on tonsillar lymphoid B cells. Br J Haematol. Sep 1997;98(4):863-8. [Medline].

  24. Fasano A. Physiological, pathological, and therapeutic implications of zonulin-mediated intestinal barrier modulation. Living life on the edge of the wall. Am J Pathol. Oct 2 2008;epub ahead of print. [Medline].

  25. González-Fernández A, Gilmore D, Milstein C. Age-related decrease in the proportion of germinal center B cells from mouse Peyer's patches is accompanied by an accumulation of somatic mutations in their immunoglobulin genes. Eur J Immunol. Nov 1994;24(11):2918-21. [Medline].

  26. Greiner A, Knörr C, Seeberger H, Schultz A, Müller-Hermelink HK. Tumor biology of mucosa-associated lymphoid tissue lymphomas. Recent Results Cancer Res. 2000;156:19-26. [Medline].

  27. Hammel P, Haioun C, Chaumette MT, et al. Efficacy of single-agent chemotherapy in low-grade B-cell mucosa-associated lymphoid tissue lymphoma with prominent gastric expression. J Clin Oncol. Oct 1995;13(10):2524-9. [Medline].

  28. Harris A, Misiewicz JJ. ABC of the upper gastrointestinal tract. Management of Helicobacter pylori infection. BMJ. Nov 3 2001;323(7320):1047-50. [Medline][Full Text].

  29. Harris NL, Isaacson PG. What are the criteria for distinguishing MALT from non-MALT lymphoma at extranodal sites?. Am J Clin Pathol. Jan 1999;111(1 suppl 1):S126-32. [Medline].

  30. Hein WR. Organization of mucosal lymphoid tissue. Curr Top Microbiol Immunol. 1999;236:1-15. [Medline].

  31. Husson H, Lugli SM, Ghia P, et al. Functional effects of TNF and lymphotoxin alpha1beta2 on FDC-like cells. Cell Immunol. Aug 1 2000;203(2):134-43. [Medline].

  32. Isaacson PG. Extranodal lymphomas: the MALT concept. Verh Dtsch Ges Pathol. 1992;76:14-23. [Medline].

  33. Iwasaki A, Kelsall BL. Localization of distinct Peyer's patch dendritic cell subsets and their recruitment by chemokines macrophage inflammatory protein (MIP)-3alpha, MIP-3beta, and secondary lymphoid organ chemokine. J Exp Med. Apr 17 2000;191(8):1381-94. [Medline][Full Text].

  34. Jain SL, Michael JG. The influence of antigen digestion on orally induced immunity and tolerance. Adv Exp Med Biol. 1995;371B:1245-50. [Medline].

  35. Kuo SH, Yeh PY, et al. Overexpression of B cell-activating factor of TNF family (BAFF) is associated with Helicobacter pylori-independent growth of gastric diffuse large B-cell lymphoma with histologic evidence of MALT lymphoma. Blood. Oct 1 2008;112(7):2927-34. [Medline].

  36. Köhne G, Schneider T, Zeitz M. Special features of the intestinal lymphocytic system. Baillieres Clin Gastroenterol. Sep 1996;10(3):427-42. [Medline].

  37. Langkamp-Henken B, Glezer JA, Kudsk KA. Immunologic structure and function of the gastrointestinal tract. Nutr Clin Pract. Jun 1992;7(3):100-8. [Medline].

  38. Liu YJ, Barthélémy C, de Bouteiller O, et al. Memory B cells from human tonsils colonize mucosal epithelium and directly present antigen to T cells by rapid up-regulation of B7-1 and B7-2. Immunity. Mar 1995;2(3):239-48. [Medline][Full Text].

  39. López-González MA, Sánchez B, Mata F, Delgado F. Tonsillar lymphocyte subsets in recurrent acute tonsillitis and tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. Feb 1998;43(1):33-9. [Medline].

  40. Miki H, Kobayashi S, Harada H, et al. Early stage gastric MALT lymphoma with high-grade component cured by Helicobacter pylori eradication. J Gastroenterol. Feb 2001;36(2):121-4. [Medline].

  41. Moretó M, Pérez-Bosque A. Dietary plasma proteins, the intestinal immune system and the barrier functions of the intestinal mucosa. J Anim Sci. Sep 26 2008;epub ahead of print. [Medline].

  42. Mosby. Schoefer J, Nissen D, eds. Mosby's GenRx 2001: A Comprehensive Reference for Generic and Brand Prescription Drugs. St. Louis, Mo: Mosby-Year Book; 2001.

  43. Owen RL. Mid-life crisis for M cells. Gut. Jan 1998;42(1):11-2. [Medline][Full Text].

  44. Pabst R. Lymphocyte migration to the gut: oversimplifications and controversial aspects. Immunol Res. 1991;10(3-4):279-81. [Medline].

  45. Patrick MK, Gall DG. Protein intolerance and immunocyte and enterocyte interaction. Pediatr Clin North Am. Feb 1988;35(1):17-34. [Medline].

  46. Richards JW Jr. Cryptic tonsillitis. J Fam Pract. Nov 1996;43(5):502. [Medline].

  47. Rothkötter HJ, Geist M, Fritz FJ, Pabst R. Age-dependence of lymphocyte production in Peyer's patch follicles in contrast to the other Peyer's patch compartments and the thymus. Adv Exp Med Biol. 1988;237:81-5. [Medline].

  48. Sierro F, Pringault E, Assman PS, Kraehenbuhl JP, Debard N. Transient expression of M-cell phenotype by enterocyte-like cells of the follicle-associated epithelium of mouse Peyer's patches. Gastroenterology. Sep 2000;119(3):734-43. [Medline].

  49. Syrjänen S, Syrjänen K, Horsmanheimo M. Structure and function of salivary glands in psoriatics. Arch Dermatol Res. 1982;274(3-4):295-301. [Medline].

  50. Yamamoto M, Rennert P, McGhee JR, et al. Alternate mucosal immune system: organized Peyer's patches are not required for IgA responses in the gastrointestinal tract. J Immunol. May 15 2000;164(10):5184-91. [Medline][Full Text].

  51. Zinzani PL, Magagnoli M, Galieni P, et al. Nongastrointestinal low-grade mucosa-associated lymphoid tissue lymphoma: analysis of 75 patients. J Clin Oncol. Apr 1999;17(4):1254. [Medline][Full Text].

Further Reading

Keywords

mucosa-associated lymphoid tissue, lymphoid tissue, MALToma, MALT lymphoma, MALT, marginal zone B-cell lymphoma, lymph node, mucus membrane, mucus, mucosal tissue, tonsils, Peyer patches, Peyer's patches, vermiform appendix, non-Hodgkin lymphoma, non-Hodgkin's lymphoma, NHL, lymphoma, malignancy, malignancies, cancer, Hashimoto thyroiditis, Hashimoto's thyroiditis, Crohn disease, Crohn's disease, celiac disease, Sjögren syndrome,
gut-associated lymphoid tissue, GALT, bronchial/tracheal-associated lymphoid tissue, BALT, nose-associated lymphoid tissue, NALT, vulvovaginal-associated lymphoid tissue, VALT, gastric MALT lymphoma, nongastric MALT lymphoma, gastric MALToma, nongastric MALToma, human mucosa

Contributor Information and Disclosures

Author

Sara J Grethlein, MD, Associate Dean for Graduate Medical Education, Professor, Department of Internal Medicine, Division of Hematology and Oncology, State University of New York Upstate Medical University
Sara J Grethlein, MD is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Coauthor(s)

Jose A Perez Jr, MD, MSEd, MBA, Consulting Physician, Department of Internal Medicine, Residency Director, Vice Chair of Education Department of Medicine, The Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College
Jose A Perez Jr, MD, MSEd, MBA is a member of the following medical societies: American College of Physician Executives, American College of Physicians, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Troy H Guthrie, Jr, MD, Director of Cancer Institute, Baptist Medical Center
Troy H Guthrie, Jr, MD is a member of the following medical societies: American Federation for Medical Research, American Medical Association, American Society of Hematology, Florida Medical Association, Medical Association of Georgia, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.