Neoplasia: infection-associated lymphoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: infection-associated lymphoma

Sample item

A 55-year-old man has dyspepsia. Gastric biopsy shows a dense infiltrate of small centrocyte-like cells invading glands to form lymphoepithelial lesions, and Helicobacter pylori is present. Staging shows disease confined to the stomach. What is the most appropriate initial treatment?

AWhole-abdomen radiotherapyBHelicobacter pylori eradication therapyCR-CHOP combination chemotherapyDTotal gastrectomy with D2 lymphadenectomy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Helicobacter pylori eradication therapy

Gastric extranodal marginal zone (MALT) lymphoma arises from lymphoid tissue acquired in response to chronic H. pylori infection. Early-stage H. pylori-positive disease often regresses with eradication therapy alone, although tumours with t(11;18) respond poorly. Radiotherapy is reserved for persistent or H. pylori-negative disease.

Option by option

A. Whole-abdomen radiotherapy
Radiotherapy to the stomach is a second-line option, and whole-abdomen fields are not appropriate for localised disease.
B. Helicobacter pylori eradication therapy (correct)
Eradication removes the antigenic drive and induces remission in most early-stage cases.
C. R-CHOP combination chemotherapy
R-CHOP is used for aggressive lymphomas such as diffuse large B-cell lymphoma, not as first-line treatment for localised H. pylori-driven MALT lymphoma.
D. Total gastrectomy with D2 lymphadenectomy
Gastrectomy is an unnecessarily extensive operation for a lymphoma that usually responds to antibiotics.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Helicobacter pylori eradication therapy. Gastric extranodal marginal zone (MALT) lymphoma arises from lymphoid tissue acquired in response to chronic H.

Why is "Whole-abdomen radiotherapy" not the answer?

Radiotherapy to the stomach is a second-line option, and whole-abdomen fields are not appropriate for localised disease.

Why is "R-CHOP combination chemotherapy" not the answer?

R-CHOP is used for aggressive lymphomas such as diffuse large B-cell lymphoma, not as first-line treatment for localised H. pylori-driven MALT lymphoma.

Why is "Total gastrectomy with D2 lymphadenectomy" not the answer?

Gastrectomy is an unnecessarily extensive operation for a lymphoma that usually responds to antibiotics.

What concept does this question test?

It tests Neoplasia: infection-associated lymphoma in Pathology. pylori infection. Early-stage H. pylori-positive disease often regresses with eradication therapy alone, although tumours with t(11;18) respond poorly. Radiotherapy is reserved for persistent or H. pylori-negative disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: infection-associated lymphoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.