A case of gastric malt lymphoma in which NBI magnifying endoscopy was useful in differentiating it from gastric cancer

A 65-year-old woman underwent screening employing upper gastrointestinal endoscopy at a local hospital, and was found to have a depressed lesion in the greater curvature of the gastric antrum, suggestive of an undifferentiated carcinoma. Multiple biopsy specimens were taken during endoscopic examination on two occasions, but a diagnosis could not be made from them. She was referred to our hospital for further evaluation. NBI magnifying endoscopy of the posterior wall away from the depression that was detected on standard endoscopy, showed a shiny area with a tendency to lose the mucosal microstructure at a mucosal site where no abnormalities were previously detected on ordinary observation and dye spraying, and had a tree-like appearance (TLA), which refers to images of abnormal blood vessels looking like branches from the trunk of a tree. Targeted biopsies were performed in this site under NBI magnifying observation, leading to a diagnosis of MALT lymphoma. Thus, the TLA observed by NBI magnifying endoscopy may be a finding suggestive of the infiltration of MALT lymphoma cells in the mucosa. The results in this case suggest that recognition of this finding provides useful information for the selection of optimal biopsy sites.