Video Endoscopic Sequence 1 of 12.

Gastroduodenal MALToma

Mucosa-Associated Lymphoid Tissue Lymphoma

 Endoscopy shows nodular erosions with necrotic material
 of the gastric body and fundus as well as larger irregular
 ulcers of the third portion of duodenus.

 It has long been known that the stomach is the most
 common location of lymphoma within the gastrointestinal
 tract. However, it is only in the past few decades that the
 reason for this fact has been found. The discovery of
 gastric Helicobacter pylori infection and its role in the
 pathogenesis of chronic gastritis, lymphoma and probably
 gastric carcinoma has revolutionized our definition of
 malignancy. The concept of a pathway of lymphoid
 hyperplasia (chronic gastritis) leading to lymphoid
 “dysplasia” (atypical lymphoid infiltrates) that further
 evolves into a proliferation that fulfils criteria for
 malignancy (lymphoma) has been compared to the
 adenoma-carcinoma sequence in epithelial neoplasia.

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Video Endoscopic Sequence 2 of 12.

Gastroduodenal MALT lymphoma

 Endoscopy shows large erosion, biopsies were positive to be a maltoma.

 Mucosa-Associated Lymphatic Tissue (MALT) Lymphoma
 is a very rare type of Non-Hodgkin’s Lymphoma. MALT
 tissue is lymphatic tissue that is found in the stomach,
 lungs, thyroid, salivary glands, intestines, and eyes, so it is
 classified as "extranodal" (out of the nodes). MALToma
 typically results from a mutation of B-cells in this
 extranodal tissue. It is an indolent, or slow growing, cancer.

 MALToma can arise in any organ with MALT tissue.
 Though the stomach is the affected organ in most cases
 (2 out of 3), the lungs, thyroid, and eyes can be involved
 also. This cancer is associated with several diseases and
 conditions, such as the bacteria Helicobacter pylori,
 Sjogren Syndrome, Celiac Disease, Chron’s Disease, or
 Hashimoto Thyroiditis.

Video Endoscopic Sequence 3 of 12.

Duodenal MALT lymphoma

This lesion is located in the third portion of the duodenum.

Video Endoscopic Sequence 4 of 12.

Duodenal MALT lymphoma

Third portion of the duodenum

Video Endoscopic Sequence 5 of 12.

Endoscopy Shows large and deep ulcers

 The concept of mucosa-associated lymphoid tissue
 (MALT) lymphomas was introduced by Isaacson and
 Wright [ Cancer 1983; 52:1410–1416[CrossRef][Medline]
 in 1983. After more than 20 years of clinical research
 MALT lymphomas are now recognized as a distinct
 subtype of non-Hodgkin’s lymphoma (NHL) with unique
 pathogenic, histological, and clinical features. Although this
 subtype of NHL occurs frequently, optimal management
 remains elusive.

Video Endoscopic Sequence 6 of 12.

 Endoscopy shows multiple large and deep ulcers in the
 third portion of the duodenum.

Video Endoscopic Sequence 7 of 12.

Again the video endoscopy displays several large and deep ulcers.

Video Endoscopic Sequence 8 of 12.

 Differential Diagnosis: Gastritis or Low Grade MALT
 Lymphoma?.

 Distinguishing severe chronic gastritis from low grade
 MALT lymphoma is the most common diagnostic dilemma
 in gastric biopsies containing dense lymphocytic infiltrates.
 In practice, the distinction between the two can often be
 easily accomplished histologically. In more difficult cases,
 immunohistochemistry and PCR analysis may be required
 to arrive at the correct diagnosis. In the following
 discussion, bare in mind that lymphoma occurs in a
 background of chronic H. pylori related gastritis.
 Therefore, a mixture of gastritis and lymphoma in biopsies
 is the rule, not the exception.

Video Endoscopic Sequence 9 of 12.

 Endoscopic view of a malignant picture involving the
 third part of the duodenum.

 H pylori infection has been associated with gastric MALT
 lymphomas. The role of H pylori in duodenal MALT
 lymphoma is unclear. Therapy of H pylori infection has
 been correlated with tumour regression.

Video Endoscopic Sequence 10 of 12.

Video Endoscopic Sequence 11 of 12.

Video Endoscopic Sequence 12 of 12.

Video Endoscopic Sequence 1 of 7.

Duodenal Lymphoma B cells.

 The pylorus is observed, the duodenal bulb contains
 several nodules.

Video Endoscopic Sequence 2 of 7.

Duodenal Lymphoma B cells.

 The duodenal bulb is infiltrated and ulcerated there are
 multiple tumors that thickening the lumen.

Video Endoscopic Sequence 3 of 7.

 The image and the video display the third portion of the
 duodenus.
 This image displays several tumors varying in size length.
 

Video Endoscopic Sequence 4 of 7.

Duodenal Lymphoma B cells.

Video Endoscopic Sequence 5 of 7.

 The lumen is compromised by marked thickening and
 crowding of the circular folds.
          

Video  Endoscopic Sequence 6 of 7.

There are several sub mucosal tumors.

Video Endoscopic Sequence 7 of 7.

Stomach retroflexed view.

 The image and the video display multiple small nodules.