胃粘膜相关淋巴组织（MALT）淋巴瘤在历史上与幽门螺杆菌（HP）感染有关，超过80%的患者存在HP感染。然而，HP阴性的MALT淋巴瘤的发病率正在增加。这些患者的临床病理特征尚未得到充分研究，并且最佳治疗策略仍不清楚。 从2000年到2017年，我们检索了病理数据库中的原发性胃MALT淋巴瘤的诊断资料。对临床数据和切片进行了审查。根据分析，将病例分为伴有慢性胃炎和HP感染背景的病例，伴有慢性胃炎但无HP感染的病例，以及既无慢性胃炎背景也无HP感染的病例。 在70例胃MALT淋巴瘤病例中，有26例（总数的37%）患者存在慢性胃炎，并在组织学上为HP阳性（n = 23）或在额外实验室检测中为HP阳性（n = 3）。其余44例（总数的63%）病例组织学上为HP阴性。在HP阴性的病例中，有5例（HP阴性病例的11%）显示组织学上存在胃炎，而39例（HP阴性病例的89%）通过切片审查（n = 18）或可用的病理报告（n = 21）并没有足够的胃炎证据。在初步诊断时，HP阴性病例中无胃炎的病例显示出更高的肠镜下肿物的倾向，与HP阳性病例相比（37.5% vs 11.1%，P = .02）。两组之间的免疫表型和B细胞基因重排阳性率无显著差异。虽然所有HP阳性患者接受了HP清除的抗生素治疗，HP阴性组的治疗则包括不同的抗生素、放疗、利妥昔单抗或化疗。在可得到的随访数据中，13例（39%）HP阴性患者复发，与HP阳性患者的复发率相似；然而，迄今为止，两组患者中没有人因该病而死亡。 HP阴性MALT淋巴瘤的发病率正在增加，在我们的实践中，它目前比与HP相关的MALT淋巴瘤更常见。HP阴性MALT淋巴瘤伴有慢性胃炎的病理生理学尚不清楚。我们研究中的随访数据表明，尽管管理方式不同，但这些病例的预后仍然良好。 © 2023作者。由牛津大学出版社代表美国临床病理学会出版。版权所有。有关权限，请发送电子邮件至：journals.permissions@oup.com。

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is historically associated with Helicobacter pylori (HP) infections in more than 80% of patients. However, the incidence of HP-negative MALT lymphoma has been increasing. The clinicopathologic features have not been well studied, and optimal management strategies remain unclear.The pathology database was searched for primary gastric MALT lymphomas diagnosed from 2000 to 2017. The clinical data and the slides were reviewed. The cases were divided for analysis into those with a background of chronic gastritis with HP, chronic gastritis without HP, and without either a background of chronic gastritis or HP.Of 70 gastric MALT lymphoma cases identified, 26 (37% of total) had chronic gastritis and were positive for HP histologically (n = 23) or were HP positive by additional laboratory testing (n = 3). The remaining 44 (63% of total) cases were HP negative by histology. Within the HP-negative cases, 5 (11% of HP-negative cases) showed histologic gastritis while 39 (89% of HP-negative cases) did not have sufficient evidence of gastritis through review of slides (n = 18) or based on available pathology reports (n = 21). The HP-negative cases without gastritis had higher propensities to show a mass lesion on endoscopy compared with HP-positive cases (37.5% vs 11.1%, P = .02) at the initial diagnosis. The immunophenotype and rate of positive B-cell gene rearrangement were not significantly different between the 2 groups. While all HP-positive patients received antibiotics for HP eradication, treatment in the HP-negative group varied among antibiotics, radiation, rituximab, or chemotherapy. Among HP-negative patients with available follow-up, 13 (39%) showed disease recurrence, similar to the recurrence rate in HP-positive patients; however, no individual from either group has died of the disease thus far.The incidence of HP-negative MALT lymphoma is increasing, and in our practice, it is currently more common than HP-associated MALT lymphomas. The pathophysiology of HP-negative MALT lymphoma without chronic gastritis remains unclear. Follow-up data in our study suggest that the prognosis of these cases is excellent despite varied management modalities.© The Author(s) 2023. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.