Gastric mucosa-associated lymphoid tissue lymphoma in pregnancy: diagnostic and therapeutic challenges

A Case Report

Abstract

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is exceedingly rare in pregnancy and poses unique diagnostic and therapeutic challenges. Its presentation may be nonspecific, often mimicking common gastrointestinal disorders, leading to delayed diagnosis and management. 

We report a rare case of gastric MALT lymphoma presenting as upper gastrointestinal bleeding (UGIB) in a 44-year-old woman in her second trimester of pregnancy. The patient was initially treated for bleeding peptic ulcer disease; however, endoscopic evaluation revealed an ulcerating gastric mass along the greater curvature, initially suspected to be gastric adenocarcinoma. Histopathologic examination of the endoscopic biopsy was inconclusive for malignancy. Persistent anemia due to ongoing bleeding necessitated exploratory laparotomy and radical total gastrectomy with D2 dissection, Roux-en-Y esophagojejunostomy, tube jejunostomy, and JP drain placement. Definitive histopathology confirmed gastric MALT lymphoma. The patient was subsequently advised to undergo chemotherapy 4–6 weeks postoperatively.

This case underscores the diagnostic dilemma and therapeutic complexity of managing gastric MALT lymphoma during pregnancy, where clinical decisions must balance fetal safety and maternal curative intent. Early recognition, multidisciplinary coordination among obstetric, surgical, oncologic, and pathology teams, and individualized management are essential for optimizing outcomes. Awareness of this rare presentation can aid clinicians in maintaining a high index of suspicion for gastric lymphoma in pregnant patients presenting with atypical or refractory upper gastrointestinal bleeding.

Keywords: Gastric MALT lymphoma, non-Hodgkin lymphoma, pregnancy, upper gastrointestinal bleeding