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Mucosa-associated lymphoid tissue (MALT) lymphoma

Written2005-12Antonio Cuneo, Gianluigi Castoldi
Hematology Section, Department of Biomedical Sciences, University of Ferrara, Corso Giovecca 203, Ferrara, Italy

(Note : for Links provided by Atlas : click)


ICD-Morpho 9699/3 Extranodal marginal zone lymphoma of mucosa- associated lymphoid tissue (MALT lymphoma); Nodal marginal zone lymphoma; Paediatric nodal marginal zone lymphoma
Atlas_Id 2095
  t(11;18)(q21;q21) FISH - Courtesy Charles Bangs, Ilana Galperin

Clinics and Pathology

Disease MALT lymphoma is the extra-nodal presentation of marginal zone B-cell lymphomas (MZBCL)
Phenotype / cell stem origin The morphologic and phenotypic characteristics of malignant cells correspond to those of lymphocytes belonging to the marginal zone, harbouring hypermutated IgV genes with the following immunophenotype: pan-B+; CD5-/+; CD10-; CD23-; CD11c+/-; cyIg +(40% of the cells), sIgM+ bright; sIgD-
Epidemiology The incidence of extra-nodal MZBCL of MALT type in western countries is approximately 7% of all NHL diagnosed by histologic examination.
  • Extra-nodal MZBCL of MALT type is an indolent disease involving most often the stomach, where it usually follows chronic gastritis due to Helicobacter pylori (HP) infection. The disease may also localize in the lung, the thyroid the salivary gland and in the orbit, where an association was documented with Chlamydia Psittaci infection
  • AS with other clinicopathological forms of MZBCL (i.e. splenic MZBCL and nodal MZBCL) transformation into high grade lymphoma may occur.
  • Pathology The tumour consists of a cytologically heterogeneous infiltrate including centrocyte-like cells, monocytoid B-cells small lymphocytes and plasma cells. Large cells and/or blast-like cells may be present. Typically, lymphoepithelial lesions are seen in the stomach.
    Treatment Low grade MALT with limited disease involving the stomach is usually HP+ and respond to eradication of the HP infection. Cases presenting at a more advanced stage or with transformation into high grade lymphoma require single-agent or multi-agent chemotherapy. Rituximab (anti-CD20 monoclonal antibody) is an effective treatment. Gastrectomy is indicated in non-responding patients.
    Prognosis The patients usually have prolonged survival, as in other indolent lymphomas, but some cases may feature an aggressive disease.


    Cytogenetics Molecular The most common anomalies in extra-nodal MZBCL of MALT type include:
  • the t(11;18)(q21;q21) / API2-MLT fusion, having a 20-50% incidence. The translocation is associated with low-grade MALT lymphoma of the stomach, and of the lung. Importantly, this translocation was associated with increased rates of persistent disease or recurrence after HP eradication therapy.
  • the translocation t(14;18)(q32;q21)/IgH-MLT1 fusion, leading to enhanced MLT1 expression may occur in 10-20% of all MALT lymphomas. It is associated with MALT lymphoma of the liver, skin, ocular adnexa, lung and salivary gland. It was not found in MALT lymphomas of the stomach, intestine, thyroid, or breast.
  • The translocation t(1;14)(p22;q32) and/or the corresponding deregulation or rearrangement of >CC: TXT: BCL10 ID: 222> at 1p22 is another recurrent chromosome aberration in a minority of cases (6% by molecular genetics, including cases with BCL10 mutations and small deletions not detectable by cytogenetics) and it appears to be more frequent in high grade-MALT than in low grade MALT lymphoma.
  • the t(3;14)/IgH-FOXP1 fusion may occur in 10% of all MALT lymphomas. It is associated with MALT lymphoma of the orbit, of the thyroid and skin, whereas it was not found in MALT lymphoma of the stomach, of the salivary gland and in other forms of MZBCL.
  • Trisomy 3 and trisomy 18 were reported in low-grade as well as high-grade MALT lymphoma. FISH studies found a 20-60% incidence for + 3, the difference being possibly accounted for by the variable sensitivity of methods adopted in different studies and by heterogeneity of patient populations. At the present time, there is no evidence that +3 plays an important role in disease progression. Trisomy 18 was observed more frequently in high grade MALT than in low grade MALT lymphomas.

    BCL6 rearrangements were documented to occur in a minority of cases, especially in the presence of a high-grade component.

  • Result of the chromosomal anomaly

    Fusion Protein
  • MALT1 overexpression and API2-MALT fusion confer constitutional NFkB activity. This, in turn, leads to enhanced proliferation and resistance to apoptosis by B lymphocytes.
  • BCL10 functions in conjunction with intracellular proteins (Carma1 and MALT1), producing the ubiquitination of NFkB inhibitor, leading to NFkB activation. These findings, along with the documented role of BCL10 in promoting survival of antigen-stimulated lymphocytes, suggest the IgH/BCL10 translocation may contribute to lymphomagenesis by enhancing BCL10 function.

    To be noted

    Additional cases are needed to delineate the epidemiology of this rare entity:
    you are welcome to submit a paper to our new Case Report section.


    A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project.
    Blood. 1997 ; 89 (11) : 3909-3918.
    PMID 9166827
    Translocation t(11;18) absent in early gastric marginal zone B-cell lymphoma of MALT type responding to eradication of Helicobacter pylori infection.
    Alpen B, Neubauer A, Dierlamm J, Marynen P, Thiede C, Bayerdörfer E, Stolte M
    Blood. 2000 ; 95 (12) : 4014-4015.
    PMID 10939796
    Molecular cytogenetic characterization of marginal zone B-cell lymphoma: correlation with clinicopathologic findings in 14 cases.
    Cuneo A, Bigoni R, Roberti MG, Milani R, Agostini P, Cavazzini F, Minotto C, De Angeli C, Bardi A, Tammiso E, Negrini M, Cavazzini P, Castoldi G
    Haematologica. 2001 ; 86 (1) : 64-70.
    PMID 11146573
    Detection of t(11;18)(q21;q21) by interphase fluorescence in situ hybridization using API2 and MLT specific probes.
    Dierlamm J, Baens M, Stefanova-Ouzounova M, Hinz K, Wlodarska I, Maes B, Steyls A, Driessen A, Verhoef G, Gaulard P, Hagemeijer A, Hossfeld DK, De Wolf-Peeters C, Marynen P
    Blood. 2000 ; 96 (6) : 2215-2218.
    PMID 10979968
    BCL10 gene mutation in lymphoma.
    Du MQ, Peng H, Liu H, Hamoudi RA, Diss TC, Willis TG, Ye H, Dogan A, Wotherspoon AC, Dyer MJ, Isaacson PG
    Blood. 2000 ; 95 (12) : 3885-3890.
    PMID 10845924
    Frequent mutation of bcl-6 proto-oncogene in high grade, but not low grade, MALT lymphomas of the gastrointestinal tract.
    Gaidano G, Capello D, Gloghini A, Fassone L, Vivenza D, Ariatti C, Migliazza A, Saglio G, Carbone A
    Haematologica. 1999 ; 84 (7) : 582-588.
    PMID 10406897
    World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997.
    Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, Lister TA, Bloomfield CD
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 1999 ; 17 (12) : 3835-3849.
    PMID 10577857
    MALT1 and the API2-MALT1 fusion act between CD40 and IKK and confer NF-kappa B-dependent proliferative advantage and resistance against FAS-induced cell death in B cells.
    Ho L, Davis RE, Conne B, Chappuis R, Berczy M, Mhawech P, Staudt LM, Schwaller J
    Blood. 2005 ; 105 (7) : 2891-2899.
    PMID 15598810
    Gastric low-grade MALT lymphoma, high-grade MALT lymphoma and diffuse large B cell lymphoma show different frequencies of trisomy.
    Hoeve MA, Gisbertz IA, Schouten HC, Schuuring E, Bot FJ, Hermans J, Hopman A, Kluin PM, Arends JW, van Krieken JH
    Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K. 1999 ; 13 (5) : 799-807.
    PMID 10374886
    Resistance of t(11;18) positive gastric mucosa-associated lymphoid tissue lymphoma to Helicobacter pylori eradication therapy.
    Liu H, Ruskon-Fourmestraux A, Lavergne-Slove A, Ye H, Molina T, Bouhnik Y, Hamoudi RA, Diss TC, Dogan A, Megraud F, Rambaud JC, Du MQ, Isaacson PG
    Lancet. 2001 ; 357 (9249) : 39-40.
    PMID 11197361
    The product of the t(11;18), an API2-MLT fusion, is an almost exclusive finding in marginal zone cell lymphoma of extranodal MALT-type.
    Maes B, Baens M, Marynen P, De Wolf-Peeters C
    Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 2000 ; 11 (5) : 521-526.
    PMID 10907943
    Clinical activity of rituximab in gastric marginal zone non-Hodgkin's lymphoma resistant to or not eligible for anti-Helicobacter pylori therapy.
    Martinelli G, Laszlo D, Ferreri AJ, Pruneri G, Ponzoni M, Conconi A, Crosta C, Pedrinis E, Bertoni F, Calabrese L, Zucca E
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005 ; 23 (9) : 1979-1983.
    PMID 15668468
    The t(11;18)(q21;q21) chromosome translocation is a frequent and specific aberration in low-grade but not high-grade malignant non-Hodgkin's lymphomas of the mucosa-associated lymphoid tissue (MALT-) type.
    Ott G, Katzenberger T, Greiner A, Kalla J, Rosenwald A, Heinrich U, Ott MM, Müller-Hermelink HK
    Cancer research. 1997 ; 57 (18) : 3944-3948.
    PMID 9307277
    Primary pulmonary MALT lymphomas show frequent and heterogeneous cytogenetic abnormalities, including aneuploidy and translocations involving API2 and MALT1 and IGH and MALT1.
    Remstein ED, Kurtin PJ, Einerson RR, Paternoster SF, Dewald GW
    Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K. 2004 ; 18 (1) : 156-160.
    PMID 14574335
    T(3;14)(p14.1;q32) involving IGH and FOXP1 is a novel recurrent chromosomal aberration in MALT lymphoma.
    Streubel B, Vinatzer U, Lamprecht A, Raderer M, Chott A
    Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K. 2005 ; 19 (4) : 652-658.
    PMID 15703784
    Bcl10 can promote survival of antigen-stimulated B lymphocytes.
    Tian MT, Gonzalez G, Scheer B, DeFranco AL
    Blood. 2005 ; 106 (6) : 2105-2112.
    PMID 15878976
    Long-term follow-up of gastric MALT lymphoma after Helicobacter pylori eradication.
    Wündisch T, Thiede C, Morgner A, Dempfle A, Günther A, Liu H, Ye H, Du MQ, Kim TD, Bayerdörffer E, Stolte M, Neubauer A
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005 ; 23 (31) : 8018-8024.
    PMID 16204012
    B-cell lymphoma of MALT type: a review with special emphasis on diagnostic and management problems of low-grade gastric tumours.
    Zucca E, Roggero E, Pileri S
    British journal of haematology. 1998 ; 100 (1) : 3-14.
    PMID 9450784


    This paper should be referenced as such :
    Cuneo, A ; Castoldi, GL
    Mucosa-associated lymphoid tissue (MALT) lymphoma
    Atlas Genet Cytogenet Oncol Haematol. 2006;10(3):177-179.
    Free journal version : [ pdf ]   [ DOI ]
    On line version :

    Other genes implicated (Data extracted from papers in the Atlas) [ 8 ]


    External links

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