MALT Lymphoma of the Urinary Bladder Shows a Dramatic Female Predominance, Uneven Geographic Distribution, and Possible Infectious Etiology

Figures & data

Figure 1 Axial CT images showing multiple abnormal nodular thickening on the anterior (A) and posterior (B) bladder walls.

Figure 2 Bladder MALT lymphoma. The histologic sections show a dense, abnormal lymphocytic proliferation right beneath the urothelial surface of urinary bladder mucosa (A and B) the neoplastic cells are positive for CD20 (C) and CD79a (D).

Figure 3 Axial CT image of depicting the bladder and showing no evidence of abnormal nodularity 3 months later.

Table 1 Urinary Bladder MALT Lymphoma Cases: Diagnostics and Treatment

Case No.	Age (y.o.)	Sex	Immunohistochemistry	FISH and Molecular Study	Treatment	Follow-Up	Cystitis (Present/Absent/N/A)	Urine Culture (a Bug/Negative/N/A)	Country of Origin	Year of Report	Reference
1	56	F	Positive: CD20 (L26), CD79a (MB1) Negative: CD43 (MT1), CD45RO (UCHL1) Lambda light chain restricted	N/A	Total cystectomy	9 months after surgery, negative for recurrence	Present	Enterococcus	Japan (Asia)	1990	Kuhara et al^Citation3
2	67	F	Positive: CD20 (L26)	N/A	Chemotherapy (CHOP)	24 months follow-up, negative for recurrence	Present	N/A	UK (Europe)	1993	Pawade et al^Citation12
3	74	F	Positive: CD20 (L26)	N/A	Radiotherapy	Dead (no follow-up)	Present	N/A	UK (Europe)	1993	Pawade et al^Citation12
4	22	F	Positive: CD20 (L26)	N/A	Chemotherapy and radiotherapy	46 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	1993	Pawade et al^Citation12
5	83	F	Positive: CD20 (L26)	N/A	Radiotherapy	20 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	1993	Pawade et al^Citation12
6	80	M	Positive: CD20 (L26)	N/A	Not treated	Died in 30 months after diagnosis of ischemic heart disease	Present	N/A	UK (Europe)	1993	Pawade et al^Citation12
7	73	F	Positive: CD45 (LCA), CD20 (L26), MB2 Negative: CD79a (MB1), CD45RO (UCHL1)	N/A	Chemotherapy	Died in 8 months due to unrelated to lymphoma cause. No lymphoma recurrence in bladder. Lymphoma of the thyroid.	N/A	N/A	Spain (Europe)	1996	Fernandez et al^Citation13
8	50	F	Positive: CD20 (L26), MB2 Kappa light chain restricted	N/A	Chemotherapy	60 months follow-up, negative for recurrence	N/A	N/A	Spain (Europe)	1996	Fernandez et al^Citation13
9	75	F	Positive: CD20 (L26), MB2	N/A	Chemotherapy	9 months follow-up, negative for recurrence	N/A	N/A	Spain (Europe)	1996	Fernandez et al^Citation13
10	70	F	N/A	N/A	Chemotherapy and radiotherapy	48 months follow-up, negative for recurrence	N/A	N/A	Chile (America)	1998	Gallardo et al^Citation15
11	80	F	Positive: CD20 (L26), CD79a Negative: CD3, CD5, CD10, CD23, CD43 (MT1)	N/A	Radiotherapy	16 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	1998	Yuille et al^Citation40
12	77	F	Positive: CD19, CD20, Negative: CD3, CD5, CD10, CD21, CD23, CD45RO Lambda light chain restriction	Clonal heavy-chain IgH gene rearrangement (PCR)	Transurethral resection (TUR) x 2	36 months follow-up after last TUR, negative for recurrence	Present	N/A	Japan (Asia)	1999	Ando et al^Citation16
13	27	M	N/A	N/A	Chemotherapy and radiotherapy	18 months follow-up, negative for recurrence	N/A	N/A	Japan (Asia)	2000	Kawakami et al^Citation18
14	75	F	N/A	N/A	Chemotherapy and radiotherapy	36 months follow-up, negative for recurrence	N/A	N/A	France (Europe)	2000	Tasu et al^Citation19
15	66	F	Positive: CD20	N/A	N/A	12 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2000	Bates et al^Citation17
16	79	F	Positive: CD20	N/A	N/A	No follow-up	N/A	N/A	UK (Europe)	2000	Bates et al^Citation17
17	59	F	Positive: CD20, CD43	N/A	N/A	36 months follow-up, positive for recurrence	N/A	N/A	UK (Europe)	2000	Bates et al^Citation17
18	64	F	Positive: CD20, CD45 Negative: CD43 Light chain restriction: inconclusive	Clonal heavy-chain IgH gene rearrangement (PCR)	Radiotherapy	156 months follow-up, negative for recurrence	Present	Staphylococci, Streptococci, Escherichia coli, Diphtheroid bacillus	Canada (America)	2001	Al-Maghrabi et al^Citation6
19	69	F	Positive: CD20, CD45 Negative: CD5, CD10, CD43, CD45RO Lambda light chain restriction	Clonal heavy-chain IgH gene rearrangement (PCR)	Radiotherapy	60 months follow-up, negative for recurrence	Present	Escherichia coli	Canada (America)	2001	Al-Maghrabi et al^Citation6
20	72	F	Positive: CD20, CD45 Negative: CD5, CD10, CD43, CD45RO Kappa light chain restriction	Inconclusive results of heavy-chain IgH gene rearrangement (PCR)	Radiotherapy	36 months follow-up, negative for recurrence	Present	Escherichia coli	Canada (America)	2001	Al-Maghrabi et al^Citation6
21	62	M	Positive: CD19, CD20, CD43 (focal) Negative: CD5, CD10, CD23, CD45RO Kappa light chain restriction	Clonal heavy-chain IgH gene rearrangement (PCR)	Radiotherapy	24 months follow-up, negative for recurrence	Present	Staphylococcus aureus	Canada (America)	2001	Al-Maghrabi et al^Citation6
22	65	F	Positive: CD20, CD79 Negative: IgD, CD43	N/A	Chemotherapy (CHOP)	36 months follow-up, negative for recurrence	Present	Coliform Bacteria	UK (Europe)	2001	Wazait et al^Citation20
23	70	F	Positive: CD20, CD79 Negative: CD43	N/A	Chemotherapy (Chlorambucil)	60 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2001	Wazait et al^Citation20
24	70	F	Positive: CD20 Negative: CD43	N/A	Chemotherapy and radiotherapy	48 months follow-up, negative for recurrence	N/A	N/A	Chile (America)	2001	Painemal Duarte et al^Citation43
25	59	M	Positive: CD20, CD79a Negative: CD3, CD5, CD10, CD23, CD43, CD45RO, BCL6, cyclin D1	N/A	Antibiotics (First paper to use HP eradication therapy which works; H. Pilori test was positive)	36 months follow-up, negative for recurrence	Absent	Negative	Netherland (Europe)	2002	van den Bosch et al^Citation7
26	57	M	Positive: CD20 Negative: CD3, CD5, CD10, CD23, CD43, cyclin D1 Ki-67 - low	Negative for t(14;18) Trisomy of Chromosome 3	Antibiotics treatment against H. Pilori (even H. Pilori test was negative)	36 months follow-up, negative for recurrence	N/A	N/A	Germany (Europe)	2002	Krober et al^Citation11
27	78	F	Positive: CD20, CD79	Clonal heavy-chain IgH gene rearrangement (PCR)	Antibiotics (trimethoprim, nitrofurantoin, and cephradine)	19 months follow-up, negative for recurrence	Present	Escherichia coli	UK (Europe)	2002	Oscier et al^Citation8
28	82	F	N/A	N/A	Chemotherapy (ChlVP)	Died, negative for recurrence	N/A	N/A	UK (Europe)	2005	Hughes et al^Citation21
29	81	F	N/A	N/A	Diathermy	12 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2005	Hughes et al^Citation21
30	28	M	N/A	N/A	Chemotherapy (ChlVP)	120 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2005	Hughes et al^Citation21
31	76	F	N/A	N/A	Radiotherapy	24 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2005	Hughes et al^Citation21
32	77	M	N/A	N/A	Chemotherapy (ChlD)	48 months follow-up, negative for recurrence	N/A	N/A	UK (Europe)	2005	Hughes et al^Citation21
33	66	F	N/A	N/A	Radiotherapy	Died, negative for recurrence	Present	N/A	UK (Europe)	2005	Hughes et al^Citation21
34	85	F	N/A	N/A	Radiotherapy	Negative for recurrence	N/A	N/A	Japan (Asia)	2005	Takahara et al^Citation22
35	84	F	N/A	N/A	Chemotherapy (R-CHOP)	N/A	N/A	N/A	Japan (Asia)	2006	Kakuta et al^Citation41
36	84	F	N/A	N/A	Radiotherapy	14 months follow-up, negative for recurrence	Present	Escherichia coli	Japan (Asia)	2007	Hatano et al^Citation23
37	64	F	Positive: CD20, BCL2 Negative: CD5, CD10, cyclin D1 Ki-67 - low	Clonal heavy-chain IgH gene rearrangement (PCR)	Transurethral resection (TUR) and radiotherapy	19 months later recurred in stomach	Absent	Negative	Japan (Asia)	2007	Ueno et al^Citation24
38	69	F	Positive: CD20, CD79a Negative: CD5, CD10	N/A	Antibiotics	25 months follow-up, negative for recurrence	Present	N/A	Japan (Asia)	2008	Fujimura et al^Citation9
39	64	F	N/A	N/A	Radiotherapy	14 months follow-up, negative for recurrence	Present	Escherichia coli	Japan (Asia)	2008	Terasaki et al^Citation42
40	31	F	Ki-67 ~ 20–25%	N/A	Chemotherapy (CHOP)	N/A	N/A	N/A	UK (Europe)	2010	Sen et al^Citation25
41	88	F	Positive: CD5, CD20, CD79a, CD45, BCL2, p53 Negative: CD10, CD15, CD23, CD30, CD34, CD43, CD56, cyclin D1, TdT Lambda light chain restriction Ki-67 ~ 50%	N/A	Antibiotics	5 months follow-up, negative for recurrence	N/A	N/A	Japan (Asia)	2011	Terada et al^Citation10
42	65	F	Positive: CD20, BCL2 Negative: CD3, CD5, CD10, cyclin D1, CD21, CD23, CD15, CD30 Ki-67 ~ 5–10%	N/A	Chemotherapy (R-CHOP)	Recur 12 months after treatment; died of septicemic shock secondary to a bladder abscess	Absent	N/A	Malaysia (Asia)	2011	Maninderpal et al^Citation26
43	17	F	Positive: CD20, BCL2, CD45 Ki-67 ~ 25%	N/A	Transurethral resection (TUR) and chemotherapy	24 months follow-up, negative for recurrence	N/A	N/A	Poland (Europe)	2011	Szopinski et al^Citation27
44	68	F	Positive: CD20, CD79a Negative: CD3, CD5, CD10 Kappa light chain restriction	Clonal heavy-chain IgH gene rearrangement (PCR)	Chemotherapy (rituximab)	Negative for recurrence	Absent	N/A	Japan (Asia)	2012	Morita et al^Citation28
45	72	F	N/A	N/A	Chemotherapy (rituximab) and radiotherapy	N/A	Present	N/A	Japan (Asia)	2013	Mizumo et al^Citation44
46	71	F	Positive: CD20 Negative: CD3	N/A	Transurethral resection (TUR)	N/A	Present	N/A	Japan (Asia)	2013	Takahashi et al^Citation31
47	48	M	Positive: CD20, BCL2 Negative: CD5, CD23, CD43, cyclin D1 Ki-67 ~ 5% Kappa light chain restriction	N/A	Chemotherapy (R-CHOP), radiotherapy, antibiotics	N/A	Present	Escherichia coli	Croatia (Europe)	2013	Bacalja et al^Citation30
48	72	F	Positive: CD20, CD79a, BCL2, IgD Negative: CD5, CD10, BCL6, cyclin D1 Ki-67 ~ 15%	Clonal heavy-chain IgH gene rearrangement (PCR); FISH - t(11;18)(q21;q21); Trisomy of Chromosome 3 and 18	Antibiotics (ciprofloxacinfor 6 weeks)	6 months follow-up, negative for recurrence	Present	Escherichia coli	Italy (Europe)	2013	Lucioni et al^Citation29
49	63	F	Positive: CD20, BCL2 Negative: CD3, CD5, CD10, cyclin D1 Ki-67 ~ 20% Lambda light chain restriction	Clonal heavy-chain IgH gene rearrangement (PCR)	Radiotherapy	11 months follow-up, negative for recurrence	Absent	Negative	Taiwan (Asia)	2014	Chen et al^Citation39
50	54	M	Positive: CD20 Negative: CD3, CD10, BCL6, cyclin D1	N/A	Radiotherapy	36 months follow-up, negative for recurrence	Absent	Negative	USA (America)	2014	Haddad-Lacle et al^Citation32
51	78	F	Positive: CD20, CD79a, BCL2 Negative: CD3, CD10, CD23, cyclin D1 Ki-67 ~ 20% Kappa light chain restriction	N/A	Chemotherapy (rituximab)	N/A	Present	Escherichia coli	Japan (Asia)	2014	Matsuda et al^Citation33
52	76	F	Positive: CD20, BCL2 Negative: CD3, CD10	N/A	Radiotherapy	3 months follow-up, negative for recurrence	N/A	N/A	Taiwan (Asia)	2015	Hsu et al^Citation35
53	65	F	Positive: CD20, PAX5 Negative: CD5, CD10	N/A	A transurethral resection of the bladder tumor (TURBT) and radiotherapy	3 months follow-up, negative for recurrence	N/A	N/A	USA (America)	2015	Vempati et al^Citation34
54	53	F	Positive: CD20, CD45 Negative: CD3, CD5, CD10, BCL2	N/A	Chemotherapy (R-CHOP)	9 months follow-up, negative for recurrence	Present	Negative	India (Asia)	2016	Jitani et al^Citation5
55	72	F	N/A	N/A	Transurethral resection of bladder tumors (TURBT)	13 months follow-up, negative for recurrence	N/A	N/A	Japan (Asia)	2018	Ozawa et al^Citation45
56	77	F	Positive: CD20, CD79a, BCL2	N/A	Radiotherapy	60 months follow-up, negative for recurrence	Present	Escherichia coli	Japan (Asia)	2018	Isono et al^Citation36
57	74	F	Positive: CD20	N/A	Radiotherapy	N/A	Present	Negative	Singapore (Asia)	2019	Kadam et al^Citation37
58	77	F	Positive: CD20, PAX5, BCL2, CD21 Negative: CD10, MUM1, TDT, cyclin D1	N/A	Transurethral resection of bladder tumors (TURBT)	The patient was alive and healthy at the 15-month follow-up	N/A	N/A	China (Asia)	2020	Xu et al^Citation38
59	58	F	Positive: CD20, CD79a, BCL2 Negative: CD5, CD10	N/A	Chemotherapy (rituximab)	120 months follow-up, negative for recurrence	Absent	N/A	USA (America)	2020	Lyapichev et al.

Abbreviations: F, female; M, male; y.o., years old; N/A, not available or provided not in English; CHOP, cyclophosphamide, doxorubicin, vincristine and prednisolone; R-CHOP, rituximab with CHOP; ChlVP, Chl, chlorambucil; V, vincristine; P, prednisolone; ChlD, Chl, chlorambucil; D, dexamethasone; FISH, fluorescent in situ hybridization; PCR, polymerase chain reaction.

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