Takigawa Hidehiko, Kitadai Yuki, Shimizu Daisuke, Ariyoshi Misa, Takasago Takeshi, Tsuboi Akiyoshi, Tanaka Hidenori, Yamashita Ken, Hiyama Yuichi, Kishida Yoshihiro, Urabe Yuji, Ishikawa Akira, Yuge Ryo, Kuwai Toshio, Oka Shiro
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan.
Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
Sci Rep. 2025 Aug 27;15(1):31657. doi: 10.1038/s41598-025-16512-5.
Gastric MALT lymphoma diagnosis relies on histopathological findings and immunoglobulin H gene (IgHr) rearrangement testing, which reflects monoclonal immunoglobulin proliferation. This study aimed to clarify the role of IgHr in the diagnosis, treatment prediction, and surveillance of gastric MALT lymphoma. Of the 152 suspected cases, 131 were definitively diagnosed using a combination of IgHr and pathology, with pathological findings considered the gold standard. Patients with discrepancies between IgHr and pathology underwent re-evaluation. The relationship between IgHr status, clinicopathological features, and treatment outcomes was analyzed. IgHr and histopathology were assessed over 2 years in 41 patients after pathological complete remission (pCR). IgHr positivity was 69.5% at initial biopsy and 90.8% after two biopsies. IgHr-positive cases had higher H. pylori infection rates and better CR rates post-eradication. Patients with IgHr positivity at pCR had higher recurrence rates (16.7%). IgHr positivity gradually declined among 37 non-recurrent cases (CR: 56.8%, 6 M: 45.9%, 1Y: 21.6%, 2Y: 10.8%), indicating a delay between pCR and IgH-negative conversion. Repeated biopsies may improve the accuracy of gastric MALT lymphoma diagnosis. IgHr-positive status at pCR may signal higher recurrence risk, underscoring the need for careful post-CR surveillance. Surveillance should account for potential delays in IgHr-negative conversion.
胃黏膜相关淋巴组织（MALT）淋巴瘤的诊断依赖于组织病理学检查结果和免疫球蛋白H基因（IgHr）重排检测，后者反映单克隆免疫球蛋白增殖情况。本研究旨在阐明IgHr在胃MALT淋巴瘤的诊断、治疗预测及监测中的作用。在152例疑似病例中，131例通过IgHr与病理学检查相结合得以确诊，病理检查结果被视为金标准。IgHr与病理学结果存在差异的患者接受了重新评估。分析了IgHr状态、临床病理特征与治疗结果之间的关系。对41例病理完全缓解（pCR）后的患者在2年时间内进行了IgHr和组织病理学评估。初次活检时IgHr阳性率为69.5%，两次活检后为90.8%。IgHr阳性病例幽门螺杆菌感染率更高，根除治疗后的完全缓解率更好。pCR时IgHr阳性的患者复发率更高（16.7%）。在37例未复发的病例中，IgHr阳性率逐渐下降（完全缓解时：56.8%，6个月时：45.9%，1年时：21.6%，2年时：10.8%），表明在pCR与IgH阴性转化之间存在延迟。重复活检可能提高胃MALT淋巴瘤诊断的准确性。pCR时IgHr阳性状态可能预示着更高的复发风险，强调了CR后进行仔细监测的必要性。监测应考虑到IgHr阴性转化可能出现的延迟。
