A 58-year-old woman presents to the clinic with a 6-week history of epigastric pain, nausea, and early satiety. She denies weight loss, fever, or vomiting. Her medical history is unremarkable, and she takes no medications. Vital signs are within normal limits. Physical examination reveals mild epigastric tenderness without rebound or guarding. Laboratory studies show normal complete blood count, chemistry panel, liver function tests, and lipase. An esophagogastroduodenoscopy reveals multiple small, punched-out ulcers in the gastric antrum with surrounding erythematous mucosa. Biopsy shows lymphoplasmacytic infiltration, lymphoid follicles, and Helicobacter pylori organisms on Giemsa stain.
C) Marginal zone lymphom
The patient’s epigastric pain, nausea, early satiety, and esophagogastroduodenoscopy findings of multiple small gastric ulcers with lymphoplasmacytic infiltration and lymphoid follicles, combined with Helicobacter pylori on biopsy, are characteristic of gastric marginal zone lymphoma. This low-grade B-cell lymphoma is strongly associated with H. pylori infection and is treatable in most early-stage cases.
Answer choice A: Erosive esophagitis, is incorrect. Erosive esophagitis affects the esophagus, not the stomach, with linear erosions and/or ulcers due to reflux, showing squamous epithelial damage, not gastric lymphoid infiltrates or H. pylori.
Answer choice B: Gastric adenocarcinoma, is incorrect. Gastric adenocarcinoma presents with weight loss, larger ulcers/masses on esophagogastroduodenoscopy, and malignant epithelial cells on biopsy, not lymphoid follicles or H. pylori-driven lymphoplasmacytic infiltrates.
Answer choice D: Peptic ulcer disease, is incorrect. Peptic ulcer disease, often H. pylori-related, shows chronic gastritis or single/large ulcers on esophagogastroduodenoscopy with neutrophilic inflammation, not lymphoid follicles or lymphoplasmacytic infiltration suggestive of lymphoma.
Answer choice E: Zollinger-Ellison syndrome, is incorrect. Zollinger-Ellison syndrome causes multiple peptic ulcers due to hyperacidity, with elevated gastrin levels and prominent acid-driven inflammation, not lymphoid aggregates or marginal zone lymphoma features.
Key Learning Point
Gastric marginal zone lymphoma, driven by H. pylori, presents with dyspepsia and small gastric ulcers, with biopsy showing lymphoplasmacytic infiltration and lymphoid follicles.
