Clinical management of primary gastric lymphoma

Primary gastric lymphomas of MALT (mucosa-associated lymphoid tissue) represent a distinct entity, which is documented by its own histological classification. Our knowledge about all aspects of these lymphoma has increased substantially over the last years. Epidemiological, histomorphological, molecular biological and experimental data clearly underline that Helicobacter pylori infection of the gastric mucosa without doubt plays an important role in both the development and progression of MALT lymphomas. Considering histological malignancy (low- and high-grade lymphomas) and dissemination of the disease (stage) as decisive prognostic factors and therapeutical determinants, endoscopic bioptical diagnosis as well as endoscopic ultrasound are of major importance in establishing diagnosis and clinical stage. In case of localized low-grade lymphoma, eradication of Helicobacter pylori offers a promising therapeutic option. Surgical resection and radiochemotherapy have proven to be effective treatment modalities. There is a need for randomized trials to clarify whether operative or conservative therapeutic strategies have to be favored in the future.