Zusammenfassung
Die überwiegende Mehrzahl der gastrointestinalen Lymphome manifestiert sich als niedrig malignes Marginalzonenlymphom vom MALT(mucosa-associated lymphoid tissue)-Typ im Magen und ist daher einer endoskopischen Diagnostik zugänglich. Die Stadieneinteilung erfolgt derzeit meist noch entsprechend der modifizierten Ann-Arbor-Klassifikation. Jedoch wird alternativ die an das TNM-System angelehnte Paris-Stadienteilung aufgrund ihrer detaillierteren Beschreibung sowohl des lokalen Tumorwachstums als auch der extraintestinalen Lymphomausbreitung empfohlen. Insbesondere in Bezug auf die Beurteilung der Tiefeninfiltration der Magenwand und der lokoregionären Lymphknotenbeteiligung stellt die Endosonografie das beste derzeit zur Verfügung stehende Verfahren dar und ist somit für die lokoregioniäre Stadienbeurteilung unverzichtbar. Über die Bedeutung im Rahmen des Stagings hinaus besitzt die Endosonografie bei gastralen MALT-Lymphomen einen hohen prognostischen Stellenwert bezüglich des Therapieansprechens auf eine Helicobacter-pylori-Eradikation. So wurde bei Vorliegen eines MALT-Lymphoms im endosonografischen Stadium EI 1 ein 70 - 100 %iges Ansprechen auf eine Helicobacter-pylori-Eradikationsbehandlung gezeigt. Der Stellenwert der Endosonografie im Follow-up gastraler Lymphome nach konservativer Therapie erscheint derzeit eher unklar. In Studien ergab sich keine klare Korrelation zwischen histologischem Ansprechen und endosonografischem Ergebnis. Daher kann die Endosonografie die regelmäßige endoskopisch bioptische Verlaufskontrolle im Follow-up von Patienten mit gastralem MALT-Lymphom und konservativer Therapie nicht ersetzen.
Abstract
The majority of gastrointestinal lymphomas belongs to the group of the MALT (mucosa-associated lymphoid type) lymphomas arising in the stomach, therefore rendering them accessible to endoscopy. Staging currently follows the modified Ann Arbor classification but most likely in the future, the TNM-based Paris staging system will be applied due to its detailed description of the local spread as well as the extraintestinal dissemination. For assessment of gut wall infiltration and local lymphonodular involvement, endoscopic ultrasound currently represents the standard procedure and is an essential diagnostic tool regarding locoregional staging. Additionally, the method confers a high prognostic value regarding treatment response in MALT lymphoma. In endoscopic ultrasound stage EI 1, Helicobacter pylori eradication leads in 70 - 100 % to a complete response. However, the value of endoscopic ultrasound in the follow-up of lymphomas after chemotherapy remains elusive and controversial. There is no clear correlation between histologically proven residual disease and endosonographic results. Thus, so far, endoscopic ultrasound will not replace bioptic surveillance after MALT lymphoma treatment.
Schlüsselwörter
MALT-Lymphom - Helicobacter pylori - Gastritis
Key words
MALT lymphoma - Helicobacter pylori - gastritis
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PD Dr. Oliver Al-Taie
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