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Lymphoma of the mucosa-associated lymphoid tissue (MALT) type represents a distinct clinicopathologic entity (1,2). The majority of these lymphomas occur in the stomach, but they may also be found in the thyroid and salivary glands, lung, breast, and ocular adnexa where they tend to remain localized for a prolonged period of time(3). Before therapy is initiated for these lymphomas, there is widespread consensus about the importance of thorough staging, including otolaryngologic investigation, computerized tomography of the abdomen and thorax, gastroscopy, endosonography, colonoscopy, as well as enteroclysis and bone marrow biopsy (4), since stage influences prognosis and choice of therapeutic strategies (5,6). Although endosonography is highly sensitive for focal penetration and evaluation of regional lymph nodes(7), additional methods for imaging might still be needed to facilitate clinical decision making. Because of the finding that malignant lymphomas express somatostatin receptors (SSTRs), pilot studies have been performed using somatostatin analogues as therapeutic agents (8), and radiolabeled octreotide (OCT), a longacting somatostatin analogue preferentially binding to SSTR subtypes 2 and 5, has been used for imaging of such tumors (9–11),allowing for estimation of the tumor burden after a single tracer injection. We have performed a study to investigate the potential of commercially available In-DTPA-D-Phe-OCT (OctreoScan®; Mallinckrodt Medical, Northampton, U.K.; referred to hereafter as In-OCT) for staging of patients with MALT-type lymphoma along with in vitro evaluations of SSTR expression in human samples of both gastric and extragastric origins. Histologic diagnosis of low-grade lymphoma of the MALT type was performed according to the criteria outlined by Isaacson and co-workers (1,2). In addition, immunologic phenotyping on paraffin sections demonstrated light chain restriction in all cases, indicating monoclonal B-cell proliferation, and revealed the phenotype CD20CD5CD10, which, in context with the microscopic appearance, is consistent with low-grade B-cell lymphoma of the MALT type (2). The diagnosis of high-grade lymphoma was based on the presence of large cells with a blastic appearance growing in sheets (often between glands), with or without a lowgrade component, and was also confirmed by phenotyping. In patients with a predominance of a large-cell component, the presence of a low-grade component defined the MALT origin of the lymphoma, and also pure large-cell lymphomas without evidence of extragastric spread were included. All patients underwent otolaryngologic investigation, gastroscopy with multiple biopsies, enteroclysis, colonoscopy, bone marrow biopsy, endosonography, and computed tomography scans of the thorax and abdomen. Staging was performed according to the criteria of Rohatiner et al.(4). Included in this study were 29 consecutive patients (16 females and 13 males) aged 32–88 years with histologically verified lymphoma of the MALT type in clinical stage I (16 patients) and stage II (13 patients). Eighteen patients presented with primary gastric MALTtype lymphoma: Seven patients had gastric low-grade lymphoma, two had highgrade lymphoma with a low-grade component, and nine had a lymphoma of high-grade histology. Two patients with a lymphoma of high-grade histology had undergone gastrectomy for acute perforation but had lymph nodes involved in situ, while one additional patient presented with pulmonary relapse 6 years after gastrectomy because of a lowgrade MALT-type lymphoma. Ten patients had primary extragastric manifestations of low-grade histology: Two had lymphoma of the conjunctiva, three had lymphoma of the lung, two had parotid lymphoma, and one patient each had lymphoma of the breast and the lacrimal gland. One patient with a history of Sjo ̈gren’s syndrome and involvement by low-grade MALT-type lymphoma underwent cervical lymphadenectomy for diagnosis. For imaging purposes, the commercially available OctreoScan® was used according to the manufacturer’s description, and gamma camera imaging consisting of both planar imaging and single-photon emission tomography was performed according to published standard methods(12). Informed consent according to institutional guidelines was obtained from all patients. The Ethical Board of the University of Vienna approved of the application of the tracer to humans. We examined six tumor samples obtained at surgery for expression of messenger RNA (mRNA) of SSTR subtypes (SSTR1–SSTR5) by means of northern blotting according to previously published methods(13). We also investigated two cases of low-grade MALTtype lymphoma of extragastric origin (i.e., one pulmonary lymphoma and one cervical lymph node) from patients undergoingIn-OCT scintigraphy. In addition, we evaluated four gastrectomy specimens (one low-grade lymphoma, one high-grade lymphoma with a lowgrade component, and two high-grade lymphomas) including those of two patients imaged withIn-OCT. Twentyeight patients were considered evaluable, while one patient was excluded from the analysis because additional chronic lymphocytic leukemia was present. In patients with gastric MALTtype lymphoma, results were disappoint-

Somatostatin Receptor Expression in Primary Gastric Versus Nongastric Extranodal B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type