Progression of gastritis to monoclonal B-cell lymphoma with resolution and recurrence following eradication of Helicobacter pylori

Objective. - To follow a patient with Helicobacter pylori-associated gastritis by performing serial endoscopic biopsies to observe the histologic progression of the gastritis to a monoclonal B-cell lymphoma with resolution and subsequent recurrence following eradication of H pylori organisms. Design. - A case report of a patient followed over 3 years. Main Outcome Measures. - Characteristics of the gastric mucosa as determined by histologic and gene rearrangement studies on multiple random biopsies obtained serially before and after the eradication of H pylori organisms. Results. - A progression from H pylori-associated gastritis through lymphoid hyperplasia to a monoclonal B-cell lymphoma was observed. With the techniques used, a resolution of the lymphoma was observed on eradication of H pylori organisms, with a subsequent recurrence of the lymphoma 15 months later, despite the absence of H pylori organisms. Conclusion. - The observations made of this patient support an association between H pylori and the development of a gastric monoclonal B-cell lymphoma. This lesion appears to develop in the setting of gastritis and progresses through lymphoid hyperplasia followed subsequently by the lymphoma. We speculate that this process is initially antigen driven by the organism and may subsequently become autonomous as genetic damage is accumulated, so that eradication of H pylori organisms will lead to regression of the lesion to the degree that there are autonomously proliferating cells present.