Which non-Hodgkin lymphoma is most commonly associated with Helicobacter pylori infection?

Question

Accepted Answer

B. Gastric MALT lymphoma. ## H. pylori and MALT Lymphoma

**Key Point:** Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is strongly associated with *Helicobacter pylori* infection in 90% of cases.

### Pathogenic Mechanism
1. Chronic H. pylori infection triggers persistent antigen stimulation
2. Polyclonal B-cell proliferation in gastric MALT
3. Accumulation of genetic aberrations (e.g., t(11;18) translocation)
4. Evolution to monoclonal lymphoma

**High-Yield:** H. pylori eradication therapy (triple or quadruple regimen) achieves lymphoma regression in 60–90% of early-stage gastric MALT lymphomas without translocation t(11;18).

### Clinical Features of Gastric MALT Lymphoma
- **Presentation:** Often asymptomatic, discovered incidentally on endoscopy
- **Endoscopic findings:** Nodular or ulcerated gastric mucosa
- **Histology:** Small lymphocytes infiltrating mucosa, with lymphoepithelial lesions
- **Prognosis:** Indolent course; excellent response to H. pylori eradication in early stages

**Clinical Pearl:** MALT lymphomas can arise in other sites (salivary glands, thyroid, lung) but gastric MALT is the most common and best-characterized. Extragastric MALT lymphomas are not associated with H. pylori.

### Diagnostic Algorithm

```mermaid
flowchart TD
  A[Gastric MALT Lymphoma]:::outcome --> B{H. pylori positive?}:::decision
  B -->|Yes, Stage I| C[H. pylori eradication]:::action
  B -->|No or Stage II+| D[Chemotherapy or observation]:::action
  C --> E{Regression?}:::decision
  E -->|Yes| F[Cure achieved]:::outcome
  E -->|No| G[Assess for t(11;18)]:::action
  G --> H{t(11;18) present?}:::decision
  H -->|Yes| I[Chemotherapy required]:::action
  H -->|No| J[Repeat H. pylori eradication]:::action
```

**Mnemonic:** **HP-MALT** — Helicobacter pylori, MALT lymphoma (gastric origin).

Answer

A. Lymphoplasmacytic lymphoma

Answer

C. Diffuse large B-cell lymphoma

Answer

D. Follicular lymphoma

Which non-Hodgkin lymphoma is most commonly associated with Helicobacter pylori infection?

Explanation

H. pylori and MALT Lymphoma

Pathogenic Mechanism

Clinical Features of Gastric MALT Lymphoma

Diagnostic Algorithm

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