2 articles
MALT lymphoma is the most common type of extranodal non-Hodgkin lymphoma. In two-thirds of cases, it originates in the stomach and is strongly associated with Helicobacter pylori infection. It presents a complex clinical picture, that can resemble multiple conditions, and typically follows a benign course.
Clinical case presentation
This report discusses an uncommon case of a 52-year-old female who presented to the oncologist with insignificant weight loss, episodes of melena and fatigue. The disease started in 2018 with upper gastrointestinal bleeding from a gastric ulcer caused by H. pylori, which was later eradicated. The patient underwent multiple upper endoscopies over the years, with no evidence of malignancy. During the most recent investigation, an ulcerated mass of about 20 mm with infiltration of the adjacent mucosa was found. The biochemical and serological examination was within normal values. Abdominal computed tomography revealed unexplained perigastric and intestinal lymphadenopathy. The patient underwent total gastrectomy and lymph node dissection due to suspected gastric cancer. Histological and immunohistochemical examinations confirmed advanced MALT lymphoma with tumour cells positive for cluster of differentiation 45, 20 (CD45, CD20) and B-cell lymphoma 2 (BCL2). Given the advanced stage of the disease, adjuvant polychemotherapy was also administered, and the patient's condition improved significantly.
MALT lymphoma is a rare condition that requires close attention and a high index of suspicion, even in unusual cases like the one presented. Endoscopic examination performed by an experienced specialist, accompanied by proper biopsy and a multidisciplinary team approach increases the survival rate of patients.
Hepatic amyloidosis is characterized by the deposition of fibrillar amyloid proteins, which result from light chain amyloidosis (AL) immunoglobulin fragments, in the extracellular space and the vessel walls of the liver. A case of primary hepatic amyloidosis without evidence of a primary or secondary cause of amyloid deposition is rare. This case was unique to the Republic of Moldova, presenting a diagnostic and therapeutic challenge for clinicians. Because the liver is rarely affected, this pathology remains underdiagnosed and is associated with a reserved prognosis.
An unusual case of primary hepatic amyloidosis is reported in a previously asymptomatic 59-year-old woman who presented at admission with peripheral edema, ascites, and hepatomegaly. Biochemical tests revealed severe cholestasis with normal bilirubin levels and acute liver failure. Liver damage caused by viral hepatitis or autoimmune diseases was excluded. A percutaneous bone marrow biopsy was normal, and Bence Jones protein was negative, indicating no evidence of primary amyloidosis. The definitive diagnosis was based on liver biopsy, which revealed apple green birefringence on polarizing microscopy after positive Congo red staining.
The reported case highlights the need to differentiate between infiltrative diseases, such as amyloidosis, when a patient presents with rapidly progressive severe cholestasis and acute liver failure. Future studies should focus on the availability of specific therapies for primary amyloidosis to improve the survival rate of these patients.