Helicobacter pylori-negative low-grade extranodal B-cell primary gastric mucosa-associated lymphoid tissue lymphoma

Helicobacter pylori-negative primary mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach - a primary gastric lymphoma (PGL) - is not very common. Herein, we report a 77-year-old man with the chief complaint of intermittent epigastric pain. Initial upper gastrointestinal (UGI) endoscopy showed multiple irregular ulcers (GUs) over the antrum with poor distention of the stomach, and gastric adenocarcinoma (Borrmann type IV, linitis plastica) was suspected. But the biopsy specimens of the GUs showed chronic inflammation without malignant change or H. pylori infection. Nevertheless, delayed healing of the GUs, specific endoscopic findings and enlarged paragastric lymph nodes on computed tomography of the abdomen alerted us to the possibility of PGL. After repeat UGI endoscopies, the patient was finally diagnosed with extranodal B-cell PGL. The patient received radical subtotal gastrectomy and Billroth II operation; the surgical margins were free of tumor cells. The patient was followed up in the outpatient department for 20 months, and his postoperative condition was good.