Review for 10.1186/1471-230X-2-6 (2002)

Reviewer's□report 
□Gastric□adenocarcinoma□in□a□patient□re-infected□with□H.□pylori□after□regression□of□MALT□lymphoma Title: 
with□successful□anti-H.□pylori□therapy 
Authors: 
Uday□C□Ghoshal□( ghoshal@sgpgi.ac.in )
Debashish□Guha□( sanjayguha@vsnl.net )
Santu□Bandyopadhyay□( santu@cal2.vsnl.net.in )
Chiranjib□Pal□( santu@cal2.vsnl.net.in )
Srikanta□Chakraborty□( uday_ujjala@yahoo.com )
Ujjala□Ghoshal□( ujjala@sgpgi.ac.in )
Bhaskar□B□B□Pal□( pkb@123.india.com )
Prabir□K□K□Banerjee□( pkb@123.india.com )
□2□ □24□Oct□2001 Version: Date: 
□Prof□Ekkehard□Bayerdorffer Reviewer: 
□A□paper□whose□findings□are□important□to□those□with□closely□related□research□interests Level□of□interest: 
□Accept□after□revision,□which□I□do□not□need□to□see Advice□on□publication: 
Major□comment:□This□is□one□of□the□first□reports□of□a□patient□who□developed□gastric□after□eradication□of□HP 
and□in□whom□MALT□lymphoma□has□previously□been□diagnosed.□However,□this□is□not□the□first□report.□In□ 
2000□Uemura□et□al.□presented□2□patients□who□developed□metachronous□gastric□cancer□4□years□after□ 
eradication□at□the□AGA□meeting□and□published□it□as□an□abstract□in□Gastroenterology.□Another□paper□by□ 
Morgner□et□al.□reported□3□patients□who□developed□gastric□cancer□4□and□5□years□after□eradication□of□HP□ for□early□MALT□and□has□been□published□in□the□World□J□Gastroenterology□in□2001.□Both□reports□should□ be□included□and□discussed□in□this□report.□ 
Minor□comments:□ 
Case□report:□In□the□case□report□should□be□included□whether□peri-gastric□lymphnodes□have□been□removed 
at□surgery□and□whether□they□were□infiltrated□by□the□lymphoma.□What□was□the□tumor□stage□according□to□ 
the□Ann□Arbor□classification□with□the□modifications□suggested□by□Musshoff□?,□this□should□be□included.□ 
How□was□the□lymphoma□classified□histologically□according□to□the□REAL□classification□?□Have□ lymphoepithelial□desctructions□of□glands□been□found□the□histological□sections?□ 
Have□any□staging□procedures□like□bone□marrow□punture,□throat□examination□or□CT□scan□of□the□thorax□ 
and□abdomen□been□performed□?□ 
Has□the□presence□of□HP□only□been□investigated□by□RUT□or□also□by□histology□in□every□UGI□endoscopy□?□ 
Please□specify.□ 
Had□the□patient□a□family□history□of□gastric□cancer□?□ 
Discussion:□How□many□biopsies□have□been□taken□at□the□first□UGI□endoscopy□?□and□what□was□the□level□of 
evidence□for□the□diagnosis□of□MALT□lymphoma□according□to□the□criteria□of□Wotherspoon□et□al.□1993□?□ 
Molecular□methods□as□those□to□detect□the□B-cell□monoclonality□are□not□suitable□and□moreover□not□ 
essential□to□confirm□the□diagnosis□of□MALT□lymphoma.□The□diagnosis□is□to□be□made□on□histology.□ 
Since□the□patient□was□treated□surgically□the□authors□can□not□conclude□that□the□lymphoma□regressed□in□ 
response□to□HP□eradication.□ 
In□the□opinion□of□this□reviewer□the□process□of□chronic□HP□gastritis□progressing□to□gastric□cancer□is□a□long□ 
lasting□one□occurring□over□decades.□So□the□development□of□gastric□cancer□in□this□patient□may□be□due□to□ 
the□changes□induced□by□25□years□of□HP□gastritis□he□suffered□before□eradication□rarther□than□a□ 
consequence□of□reinfection□with□HP□15□months□later.□ 
Reporting□a□single□case□authors□must□not□conclude□on□a□cause□relationship□between□HP□infection□and□ 
the□development□of□gastric□cancer.□A□conclusion□like□this□is□rarther□justified□in□a□case□of□MALT□ 
lymphoma□which□regressed□after□HP□eradication□as□the□only□treatment.□ 
The□references□1,□8□and□18□contain□typing□errors□of□authors□names.□ 
References□should□name□al□authors.□ 
Competing□interests: 
None□declared.